Much ado about ciprofloxacin and Acinetobacter

LETTER TO EDITOR

Year : 2004 | Volume : 52 | Issue : 2 | Page : 173-4

Much ado about ciprofloxacin and Acinetobacter

V Vedantham

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V Vedantham

Source of Support: None, Conflict of Interest: None

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PMID: 15283232

How to cite this article:
Vedantham V. Much ado about ciprofloxacin and Acinetobacter. Indian J Ophthalmol 2004;52:173

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Vedantham V. Much ado about ciprofloxacin and Acinetobacter. Indian J Ophthalmol [serial online] 2004 [cited 2021 Mar 9];52:173. Available from: https://www.ijo.in/text.asp?2004/52/2/173/14595

Dear Editor,

I read with great interest the article by Gopal et al,[1] on endophthalmitis caused by Acinetobacter calcoaceticus. The authors must be commended for highlighting the various salient features of intraocular infection due to the organism. However, there are certain points that need clarification.

In the "Results" section on the sensitivity pattern, the terms "sensitivity" and "susceptibility" have been used interchangeably. In fact, susceptibility as mentioned in another study[2] would mean that an organism is either wholly sensitive (often referred to as "S" in the microbiology laboratory records) or demonstrates intermediate sensitivity (refered to as "I" in the laboratory records).

There is no mention of the intravitreal antibiotics administered to the patients. This is all the more relevant since the organisms have demonstrated 0% sensitivity (or 100% resistance) and 4% sensitivity to vancomycin and ceftazidime respectively (these are usually the commonest antibiotic combinations to be administered initially).

The authors have mentioned that a good outcome was associated with resistance of the organism to fewer antibiotics (as detected by laboratory testing), and that this was a good correlation of in-vitro results with the in-vivo efficacy. It would also be worthwhile to know if the cases that worsened had received the drugs to which A.calcoaceticus was resistant. This in fact would be a stronger correlation of in-vitro results with the in-vivo efficacy. It was mentioned that one isolate was resistant to all the drugs tested and that one eye had to be eviscerated since the infection could not be eradicated. It would be interesting to know if these two cases were identical.

In the "Conclusion" the authors have mentioned ciprofloxacin to be the antibiotic of choice in such infections. Such a strong conclusion should be derived only after administering this antibiotic intravitreally, ideally in a prospective case series, upon clinical suspicion of A. Calcoaceticus endophthalmitis (whether the authors have administered intravitreal ciprofloxacin is not mentioned in the study). However, in the absence of conclusive reports about the efficacy of intravitreal ciprofloxacin,[3] systemic (oral or intravenous) ciprofloxacin that has good intraocular penetration [4],[5] could be tried as an adjunct to intravitreal antibiotics.

References

1.	Gopal L, Ramaswamy AA, Madhavan HN, Battu RR, Sharma T, Shanmugham MP, et al. Endophthalmitis caused by Acinetobacter calcoaceticus. A profile. Ind J Ophthalmol 2003; 51:335-40
2.	Kunimoto DY, Das T, Sharma S, Jalali S, Majji AB, Gopinathan U. Microbiologic spectrum and susceptibility of isolates: part II. Posttraumatic endophthalmitis. Endophthalmitis Research Group. Am J Ophthalmol 1999;128: 242-44
3.	Alfaro DV 3rd, Hudson SJ, Offele JJ, Bevin AA, Mines M, Laughlin RM, Schoderbek EJ. Experimental posttraumatic Bacillus cereus endophthalmitis in a swine model. Efficacy of intravitreal ciprofloxacin, vancomycin, and imipenem. Retina 1996;16:317-23
4.	Keren G, Alhalel A, Bartov E, Kitzes - Cohen R, Rubinstein E, Segey S, Treister G. The intravitreal penetration of orally adminsitered ciprofloxacin in humans. Invest Ophthalmol Vis Sci 1991;32:2388-92
5.	Alfaro DV, Hudson SJ, Rafanan MM, Moss ST, Levy SD. The effect of trauma on the ocular penetration of intravenous ciprofloxacin. Am J Ophthalmol 1996;122:678-83

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