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Background   Staphylococcus epidermidis  is the most common pathogen in postoperative endophthalmitis and causes various infectious eye diseases. However, there is very little information on fluoroquinolone antibiotic resistance to  S. epidermidis  identified in conjunctival microbe and analysis of related genes. Here, the authors investigated the rate of resistance to fluoroquinolones of  Staphylococcus epidermidis  isolated from normal conjunctival microbes and mutations in the quinolone-resistance determining region (QRDR).Methods  377 eye samples from 187 patients who underwent intravitreal injection and cataract surgery were included. Specimens were taken from the bilateral lower conjunctival sacs using a cotton swab and cultured. The cultures were identified using MALDI-TOP MS and  gyrA, gyrB, parC , and  parE  gene mutations of QRDR were confirmed by DNA extraction from resistant strains of  S. epidermidis  with a micro-dilution method using ciprofloxacin, levofloxacin, and moxifloxacin .Results  The culture positive rate was 61.8% (231) for 374 eye samples. Of the 303 total strains cultured,  S. epidermidis  was the most common with 33.7% (102). Ten types of gene mutations were observed in the resistant  S. epidermidis  of 21 strains. One-point mutation was observed mainly in  gyrA  and  parC , and a small number of mutations were observed in  parE  in the form of a double point mutations. When there were multiple point mutations in both  gyrA  and  parC , the highest minimum inhibitory concentration was observed.    Conclusions  The quinolone resistance rate of  S. epidermidis  increased in comparison with previous studies, and resistant  S. epidermidis  showed mostly QRDR mutations, which were mainly found in  gyrA  and  parC , and showed strong resistance when mutated in both genes.

antimicrobial resistance and infection control

Fluoroquinolone resistance of Staphylococcus epidermidis isolated from healthy conjunctiva and analysis of their mutations in quinolone-resistance determining region