1. Longitudinal Nationwide Antimicrobial Susceptibility Surveillance in Ocular Isolates: Results from Ocular TRUST 2 Penny A. Asbell, MD 1 Daniel F. Sahm, MD 2 1 Mount Sinai School of Medicine, New York, NY; 2 Eurofins Medinet, Inc, Anti-Infective Services, Herndon, VA Financial Disclosure: Dr. Asbell has served as a consultant to Inspire Pharmaceuticals and has received lecture fees from Alcon Laboratories, Allergan Pharmaceuticals, Santen Pharmaceutical, Inspire Pharmaceuticals, and Vistakon Pharmaceuticals. Dr. Sahm is a full-time employee of Eurofins Medinet, Inc., Anti-Infective Services and has received lecture fees from Vistakon Pharmaceuticals.

2. Ocular TRUST: Nationwide Antimicrobial Susceptibility Surveillance Program Ocular isolates only Initiated in 2005 Largest surveillance program with centralized in vitro susceptibility testing Annual surveys providing longitudinal data

3. Ocular TRUST 2 (2006-2007) Susceptibility testing specific to ocular isolates PathogensAntimicrobials S. aureus Ciprofloxacin S. epidermidis Gatifloxacin S. pneumoniae Levofloxacin H. influenzae Moxifloxacin Azithromycin Penicillin Polymyxin B Tobramycin Trimethoprim

4. Ocular TRUST: Participating Sites State with participating institution Participating Eye Centers (10)

5. Ocular TRUST 2: S. aureus Susceptibility MSSA (N=71) MRSA (N=84) 20 40 60 80 100 % Susceptible CIP GAT LEV MOX AZI PEN PLYX TOB TRI 18 CIP GAT LEV MOX AZI PEN PLYX TOB TRI

6. Ocular TRUST 2: Coagulase-Negative Staphylococci Susceptibility Methicillin-susceptible (N=40) Methicillin-resistant (N=52) 20 40 60 80 100 % Susceptible CIP GAT LEV MOX AZI PEN PLYX TOB TRI 44 CIP GAT LEV MOX AZI PEN PLYX TOB TRI

7. Ocular TRUST 2: S. pneumoniae and H. influenzae Susceptibility S. pneumoniae (N=198) H. influenzae (N=144) 20 40 60 80 100 % Susceptible CIP GAT LEV MOX AZI PEN PLYX TOB TRI 100 CIP GAT LEV MOX AZI PEN PLYX TOB TRI

8. Ocular TRUST 2: Overview Methicillin resistance in staphylococci marker for multi-drug resistance Fluoroquinolones most consistently active agents across ocular pathogens Fluoroquinolone susceptibility profile Gatifloxacin = Levofloxacin = Moxifloxacin Modest diminution in S. pneumoniae susceptibility to ciprofloxacin Polymixin B and penicillin most limited activity