Boston Type I Keratoprosthesis: Antibacterial Resistance and Microbiota Evaluation of Soft Contact Lenses

Abstract

To evaluate microbiota colonizing soft contact lenses (CL) in eyes with Boston type I keratoprosthesis (BKPro), and determine the prevalence of resistance to fourth-generation fluoroquinolone (FQ). Prospective, observational study. Patients with BKPro using CL as routine who were in postoperative follow-up in the Department of Ophthalmology of the Federal University of Sao Paulo, and volunteered to participate in the study. All patients were under a prophylactic scheme of topical 0.5% moxifloxacin 3 times a day and topical 5% povidone-iodine (PI) at the time of CL exchange. Patients on scheduled replacement scheme of CL had their lenses removed and sent for microbiological analysis. Standard culture methods were used for microorganism identification and susceptibility to different antibiotics was tested. Main outcome measure was prevalence of resistance to fourth-generation FQ. Among the 19 eyes, 12 eyes (63%) had at least 1 positive bacterial culture. The most prevalent isolates were Staphylococcus epidermidis and other coagulase-negative staphylococci. Actinomyces viscosus was isolated in 1 CL. Fungal cultures were all negative. Of the 12 eyes with culture bacterial growth, resistance to fourth-generation FQ (0.5% moxifloxacin) was identified in 6 different eyes (50%). None presented infectious complications. FQ-resistant bacteria were isolated in some patients. Although our prophylactic antibiotic regimen has been efficient in preventing bacterial infection, this analysis demonstrated that prophylaxis with PI and low FQ dose might increase resistance to antibiotics. Investigations in this field may help to outline future changes of prophylactic guidelines and therapeutic strategies.