200. Antimicrobial Stewardship and Ophthalmology. Time to See the Opportunities
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Background: Ophthalmology is a unique specialty. Most antimicrobials used for the prevention or treatment of ocular infections have unique routes of administration (topical or intravitreal) in doses >1000 times the MIC 90. Antimicrobial resistance in ocular pathogens has evolved with the increased use of antimicrobials. Antimicrobial stewardship in ophthalmology has not been previously investigated and we hypothesize that there are opportunities to improve the appropriate use of antimicrobials in this field by better understanding patterns of antimicrobial use and antimicrobial resistance in this population.

Methods: Retrospective review of all positive ocular bacterial and fungal cultures submitted to the Bascom Palmer Eye Institute between January 2011- December 2013. Viral cultures were excluded. Cultures were categorized by source (anterior chamber, vitreous, cornea, conjunctiva) and antimicrobial susceptibilities by organism.

Results: 5626 ocular cultures were reviewed. 47% were positive. Most common isolates were 40% Gram negatives, 42% Gram positives, 8% molds 8%. Positive cultures by source were: 2279 (42%) cornea, 1173 (47%) conjunctiva, 243 (29%) anterior chamber, 534 (39%) vitreous/wash. The most common organisms isolated were Staphylococcus aureus  668 (21%), Pseudomonas aeruginosa 459 (37%), Streptococcus viridans 162 (12%), Serratia marcescens 126 (10%), Staph. epidermidis 120 (9%). From all gram negative isolates (n=1257) 8% were resistant to moxifloxacin, 6% to ciprofloxacin and 4% to levofloxacin, 7% were resistant to aminoglycosides. Methicillin resistance in gram positives was 44% for S.aureus  and 62% for Staph.epidermidis. Only 40%% of Staphylococci were susceptible to fluoroquinolones in vitro.

Conclusion: Antimicrobial resistance is a global problem and ocular pathogens are not an exception. Our study shows an increase during the last decade of MRSA ocular infections with a high level of resistance to fluoroquinolones. Gram-negative infections were predominantly with Pseudomonas. Prudent use of antimicrobials for ocular prophylaxis and treatment of infections should be further investigated to preserve the efficacy of effective antimicrobials.

Lilian Abbo, MD1, Darlene Miller, Research Associate Professor2, Marissa Tysiak, PharmD3 and Harry Flynn, MD2, (1)Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, (2)Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, (3)University of Miami Hospital, Miami, FL

Disclosures:

L. Abbo, None

D. Miller, None

M. Tysiak, None

H. Flynn, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.