Ocular infections due to pseudomonas resistant to fourth-generation fluoroquinolones The authors have no financial interest in the subject matter of this poster Heloisa Nascimento, Aline Silveira Moriyama, Denise de Freitas, Ana Luisa Höfling-Lima Departmet of Ophthalmology Federal University of São Paulo São Paulo, Brazil

Background Pseudomonas aeruginosa Gram negative bacillus Important keratitis agent Traditionally associated to CL wear Aggressive infection P. aeruginosa Increasing rates of fluoroquinolone resistance More virulent than fluoroquinolone sensible strains More prevalent among non-CL weares Pseudomonas infections

Purpose To report the prevalence of fourth-generation fluoroquinolones resistance among Pseudomonas aeruginosa isolates from patients with keratitis at the Laboratory of Ocular Microbiology of the Federal University of São Paulo.

Methods Retrospective review of data from patients with keratitis who had cornea specimen sent to microbiological analysis at the Laboratory of Ocular Microbiology of the Federal University of São Paulo (UNIFESP) during the seven years period between July, 2002 and July, 2009 Patients whose exam confirmed P. aeruginosa were included in the study. Cases with identification of other Pseudomonas species or Pseudomonas spp were not included P. aeuruginosa isolates with resistance to any of the tested fourth-generation fluoroquinolone were selected and evaluated regarding antimicrobial susceptibility profile

P. aeruginosa keratitis Results Rates of culture proven P. aeruginosa keratitis per year and proportion of cases with resistance to fourth-generation fluoroquinolones Year P. aeruginosa keratitis P. aeruginosa fourth-generation fluoroquinolone resistant keratits 2002 6 2003 28 2004 10 2005 12 1 (8,33%) 2006 8 1 (12,5%) 2007 11 1 (9,09%) 2008 2009 13 6 (46,15%) Overall 100 10 (10%)

Results Profile and associated ocular and systemic conditions of the P. aeruginosa isolates resistant to fourth-generation fluoroquinolones Case # Year Gender Age Associated conditions 1 2005 M Contact Lens Wear 2 2006 F 67 Carcinomatosis 3 2007 63 Sepsis - ICU 4 2008 5 2009 40 Respiratory Insufficiency - ICU 6 37 Chemical ocular injury 7 47 Previous PPV 8 Corneal Ulcer 9 39 Corneal FB removal and TCL+ofloxacyn use 10 Corneal ulcer

Results Antimicrobial susceptibility profile of the P. aeruginosa isolates resistant to fourth-generation fluoroquinolones

Conclusion It is the first time Pseudomonas aeruginosa resistance to fourth-generation fluoroquinolone is noted in Brazil Increasing rates of fourth-generation fluoroquinolones resistance in Brazil after moxifloxacin and gatifloxacin eye drops became commercially available (2004) Pick prevalence of 46,15% P. aeruginosa strains resistant to fourth-generation fluoroquinolones among P. aeruginosa keratitis is alarming, with practical implications on empiric treatment to Pseudomonas keratits suspects Continued microbiological surveillance is essential

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