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Abstract：
OBJECTIVE: Ocular bacterial infections are important causes of morbidity and vision loss. Early antimicrobial therapy is necessary to save vision, but their efficacy is increasingly compromised by antimicrobial resistance (AMR). We assessed the etiology of ocular bacterial infections seen at Massachusetts Eye and Ear and investigated the molecular epidemiology and AMR profiles of contemporary isolates.
METHODS: Laboratory investigation.
METHODS: We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of leading ocular pathogens and their AMR profiles.
RESULTS: A total of 1601 isolates were collected from 2014 to 2021, with Staphylococcus aureus (n = 621), coagulase-negative staphylococci (CoNS) (n = 234), Pseudomonas aeruginosa (n = 213), Enterobacteriaceae (n = 167), and Streptococcus pneumoniae (n = 95) being the most common. Resistance was high among staphylococci, with methicillin resistance (MR) detected in 28% of S aureus and 39.8% of CoNS isolates. Multidrug resistance (MDR) was frequent among MR staphylococci (MRSA 60%, MRCoNS 76.1%). The population of S aureus isolates consisted mainly of 2 clonal complexes (CCs): CC8 (26.1%) and CC5 (24.1%). CC5 strains carried a variety of AMR markers, resulting in high levels of resistance to first-line therapies. Similarly, the population of ocular Staphylococcus epidermidis was homogenous with most belonging to CC2 (85%), which were commonly MDR (48%). Conversely, ocular S pneumoniae, P aeruginosa, and Enterobacteriaceae were often susceptible to first-line therapies and grouped into highly diverse genetic populations.
CONCLUSIONS: Our data showed that ocular bacterial infections in our patient population are disproportionately caused by strains that are resistant to clinically relevant antibiotics and are associated with major epidemic genotypes with both community and hospital associations.
METHODS: Laboratory investigation.
METHODS: We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of leading ocular pathogens and their AMR profiles.
RESULTS: A total of 1601 isolates were collected from 2014 to 2021, with Staphylococcus aureus (n = 621), coagulase-negative staphylococci (CoNS) (n = 234), Pseudomonas aeruginosa (n = 213), Enterobacteriaceae (n = 167), and Streptococcus pneumoniae (n = 95) being the most common. Resistance was high among staphylococci, with methicillin resistance (MR) detected in 28% of S aureus and 39.8% of CoNS isolates. Multidrug resistance (MDR) was frequent among MR staphylococci (MRSA 60%, MRCoNS 76.1%). The population of S aureus isolates consisted mainly of 2 clonal complexes (CCs): CC8 (26.1%) and CC5 (24.1%). CC5 strains carried a variety of AMR markers, resulting in high levels of resistance to first-line therapies. Similarly, the population of ocular Staphylococcus epidermidis was homogenous with most belonging to CC2 (85%), which were commonly MDR (48%). Conversely, ocular S pneumoniae, P aeruginosa, and Enterobacteriaceae were often susceptible to first-line therapies and grouped into highly diverse genetic populations.
CONCLUSIONS: Our data showed that ocular bacterial infections in our patient population are disproportionately caused by strains that are resistant to clinically relevant antibiotics and are associated with major epidemic genotypes with both community and hospital associations.
摘要：
目的：眼部细菌感染是发病和视力下降的重要原因。早期抗菌治疗对于挽救视力是必要的，但它们的功效越来越受到抗菌素耐药性(AMR)的影响。在这里，我们评估了在马萨诸塞州眼和耳看到的眼部细菌感染的病因，并研究了当代分离株的分子流行病学和AMR谱。
方法：实验室调查。
方法：我们使用表型测试和基因组测序的组合来鉴定主要眼部病原体的主要谱系及其AMR谱。
结果：从2014年至2021年共收集了1,601个分离株，其中金黄色葡萄球菌（n=621），凝固酶阴性葡萄球菌（CoNS；n=234），铜绿假单胞菌（n=213），肠杆菌(n=167)和肺炎链球菌(n=95)是最常见的。葡萄球菌的耐药性很高，在28％的金黄色葡萄球菌和39.8％的CoNS分离株中检测到甲氧西林耐药（MR）。多药耐药（MDR）在MR葡萄球菌中很常见（MRSA，60%;MRCoNS,76.1%）。金黄色葡萄球菌分离株的群体主要由两种克隆复合物(CC)组成:CC8(26.1%)和CC5(24.1%)。CC5菌株携带多种AMR标记,导致对一线疗法的高水平抗性。同样，眼表皮葡萄球菌的种群是同质的，大多数属于CC2（85％），常见的是MDR（48％）。相反，眼肺炎链球菌，铜绿假单胞菌和肠杆菌科通常对一线治疗敏感，并分为高度多样化的遗传种群。
结论：我们的数据表明，我们患者人群中的眼部细菌感染不成比例地由对临床相关抗生素耐药的菌株引起，并且与社区和医院协会的主要流行基因型相关。
方法：实验室调查。
方法：我们使用表型测试和基因组测序的组合来鉴定主要眼部病原体的主要谱系及其AMR谱。
结果：从2014年至2021年共收集了1,601个分离株，其中金黄色葡萄球菌（n=621），凝固酶阴性葡萄球菌（CoNS；n=234），铜绿假单胞菌（n=213），肠杆菌(n=167)和肺炎链球菌(n=95)是最常见的。葡萄球菌的耐药性很高，在28％的金黄色葡萄球菌和39.8％的CoNS分离株中检测到甲氧西林耐药（MR）。多药耐药（MDR）在MR葡萄球菌中很常见（MRSA，60%;MRCoNS,76.1%）。金黄色葡萄球菌分离株的群体主要由两种克隆复合物(CC)组成:CC8(26.1%)和CC5(24.1%)。CC5菌株携带多种AMR标记,导致对一线疗法的高水平抗性。同样，眼表皮葡萄球菌的种群是同质的，大多数属于CC2（85％），常见的是MDR（48％）。相反，眼肺炎链球菌，铜绿假单胞菌和肠杆菌科通常对一线治疗敏感，并分为高度多样化的遗传种群。
结论：我们的数据表明，我们患者人群中的眼部细菌感染不成比例地由对临床相关抗生素耐药的菌株引起，并且与社区和医院协会的主要流行基因型相关。
