Comparison of antimicrobial resistance genes on the ocular surface of patients with corneal infections in California and Malawi

Background: Antimicrobial resistance (AMR) determinants on the ocular
surface may contribute to poor treatment responses. Results: Mutations
conferring macrolide resistance were present on the ocular surface in 58%
(95% CI 44 to 71%) of the participants in Malawi and 32% (95% CI
20 to 46%) of the participants in San Francisco. Amino-glycosides
resistance genes were also common on the ocular surface with 58% (95% CI
44 to 71%) prevalence in Malawi and 21% (95% CI 12 to 35%) in San
Francisco. AMR was associated with poorer visual outcomes in
a subset of patients. Conclusions: As determined by RNA-seq,
ocular surface AMR gene mutations are common in patients
with infectious keratitis. Surveillance may be important for
infectious keratitis treatment selection as well as
providing guidance for antibiotic stewardship.