Effect of polymicrobial interactions on antimicrobial resistance: an in vitro analysis in human ocular infections

Purpose: Investigate the effect of polymicrobial interactions on antimicrobial resistance (AMR) of ocular pathogens in polymicrobial settings, compared with monomicrobial infections. Methods: Polymicrobial interactions were labeled as antagonistic, synergistic or indifferent based on a reduction, an increase or no change, respectively, in antibiotics' MIC by the Vitek 2 compact system, compared with monomicrobial pathogens. Results:Staphylococcus epidermidis showed antagonistic polymicrobial interactions (22.6%); Pseudomonas aeruginosa showed synergistic interactions (62.5%); multidrug-resistant Acinetobacter baumannii showed increased susceptibility to select antibiotics; Serratia ficaria (inherently colistin resistant) became colistin-susceptible in polymicrobial combinations. Conclusion: Both antagonistic and synergistic interactions exist among human pathogens in polymicrobial settings. Gram-positive pathogens had significantly higher antagonistic polymicrobial interactions (increased MICs: 20.4%) compared with Gram-negative ones (synergistic: 59.4%).