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Purpose  To analyze the clinical characteristics of nontuberculous mycobacterial (NTM) ocular infections and the species-specific  in vitro  antimicrobial susceptibility.    Material and Methods  In 2000 to 2011 at the National Taiwan University Hospital, multilocus sequencing of  rpoB ,  hsp65  and  secA  was used to identify NTM isolates from ocular infections. The clinical presentation and treatment outcomes were retrospectively compared between species. Broth microdilution method was used to determine the minimum inhibitory concentrations of amikacin (AMK), clarithromycin (CLA), ciprofloxacin (CPF), levofloxacin (LVF), moxifloxacin (MXF) and gatifloxacin (GAF) against all strains. The activities of antimicrobial combinations were assessed by the checkerboard titration method.    Results  A total of 24 NTM strains (13  Mycobacterium abscessus  and 11  Mycobacterium massiliense ) were isolated from 13 keratitis, 10 buckle infections, and 1 canaliculitis cases. Clinically, manifestations and outcomes caused by these two species were similar and surgical intervention was necessary for medically unresponsive NTM infection. Microbiologically, 100% of  M. abscessus  and 90.9% of  M. massiliense  ocular isolates were susceptible to amikacin but all were resistant to fluoroquinolones. Inducible clarithromycin resistance existed in 69.3% of  M. abscessus  but not in  M. massiliense  isolates. None of the AMK-CLA, AMK-MXF, AMK-GAF, CLA-MXF and CLA-GAF combinations showed synergistic or antagonistic effect against both species  in vitro .    Conclusions    M. abscessus  and  M. massiliense  are the most commonly identified species for NTM ocular infections in Taiwan. Both species were resistant to fluoroquinolones, susceptible to amikacin, and differ in clarithromycin resistance. Combined antimicrobial treatments showed no interaction  in vitro  but could be considered in combination with surgical interventions for eradication of this devastating ocular infection.

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Nontuberculous Mycobacterial Ocular Infections—Comparing the Clinical and Microbiological Characteristics between Mycobacterium abscessus and Mycobacterium massiliense