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Colistin resistance in Gram-negative ocular infections: prevalence, clinical outcome and antibiotic susceptibility patterns

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Abstract

Purpose

To study the prevalence, antibiotic susceptibility profile, clinical outcomes and plasmid-mediated transfer of colistin resistance (CLR) among Gram-negative bacilli (GNB) isolates from different ocular infections.

Design

Prospective case–control study in eastern India.

Methods

Consecutive ocular samples with GNB isolates from clinically diagnosed cases of microbial keratitis, infectious endophthalmitis and orbital infections were included. Inclusion criteria were significant GNB growth from ocular samples and > 6 weeks follow-up. Clinical outcomes were determined by disease-specific criteria for each clinical group. Antibiotic susceptibility was tested by broth microdilution for colistin and Kirby–Bauer disc diffusion method for others. Plasmid detection for CLR genes mcr-1 and mcr-2 genes was done by standard protocols.

Results

Sixty GNB isolates were studied. Overall prevalence of CLR (intrinsic plus acquired) was 40% (n = 24), acquired being 37.5% of CLR isolates (n = 9). The prevalence varied from 45.5% (10/22) and 45% (9/20) in microbial keratitis and infectious endophthalmitis, respectively, to 26.3% (5/19) in orbital infections. Clinical outcomes in CLR patients were significantly worse in microbial keratitis (p = 0.018) and orbital infections (p = 0.018), and comparable to colistin-susceptible ones (p = 0.77) in infectious endophthalmitis. CLR isolates had significantly higher resistance to Amikacin, Gentamicin and Ceftazidime but were susceptible to Piperacillin, Carbapenems and fluoroquinolones. Plasmids mcr-1 and mcr-2 were detected in 6.25% (n = 1) and 25%(n = 4), respectively, of the 16 tested isolates.

Conclusions

CLR is highly prevalent in ocular isolates and affects clinical outcomes. CLR isolates may still remain susceptible to Carbapenems, Piperacillin and fluoroquinolones. Plasmid mcr-1- and mcr-2-mediated CLR remains low in ocular infections.

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Acknowledgements

We thank to Aparajita Mullick, Silpa Priyadarshini, Manas Ranjan Barik, Savitri Sharma, Shivaji Sisinthy, Prity Sahay, Swati Shradhhanjali—Ocular Microbiology and Molecular Biology, L. V. Prasad Eye Institute, Bhubaneswar and Hyderabad.

Funding

This study was funded by HERF (Hyderabad Eye Research Foundation).

Author information

Authors and Affiliations

  1. Ocular Microbiology Laboratory, L V Prasad Eye Institute, MTC Campus, Patia, Bhubaneswar, Odisha, 751024, India

    Sanchita Mitra

  2. Retina and Uveitis Service, Bhubaneswar, India

    Soumyava Basu

  3. Ophthalmic Plastics, Orbit and Ocular Oncology Service, Bhubaneswar, India

    Suryasnata Rath

  4. Cornea and Anterior Segment Service, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India

    Srikant Kumar Sahu

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  1. Sanchita Mitra
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Correspondence to Sanchita Mitra.

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Conflict of interest

None of the authors report any conflict of interest.

Ethical approval

Institutional ethics committee approval (2017-91-IM-17) was taken and tenets of Declaration of Helsinki were adhered to. This study does not contain any studies with animals, performed by any of the authors.

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Informed consent was obtained from all individual participants, whose clinical information had been included in the study.

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Mitra, S., Basu, S., Rath, S. et al. Colistin resistance in Gram-negative ocular infections: prevalence, clinical outcome and antibiotic susceptibility patterns. Int Ophthalmol 40, 1307–1317 (2020). https://doi.org/10.1007/s10792-020-01298-4

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  • DOI: https://doi.org/10.1007/s10792-020-01298-4

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