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Antimicrobial therapy is commonly empirical using broad-spectrum agents with efficacy increasingly compromised by the emergence of antimicrobial resistance. We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of GPB causing keratitis and to characterize their antimicrobial resistance patterns. A total of 161 isolates, including\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      = 86), coagulase-negative staphylococci (CoNS;\n                      <jats:italic>n<\/jats:italic>\n                      = 34),\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      spp. (\n                      <jats:italic>n<\/jats:italic>\n                      = 34), and\n                      <jats:italic>Enterococcus faecalis<\/jats:italic>\n                      (\n                      <jats:italic>n<\/jats:italic>\n                      = 7), were included. The population of\n                      <jats:italic>S. aureus<\/jats:italic>\n                      isolates consisted mainly of clonal complex 5 (CC5) (30.2%). Similarly, the population of\n                      <jats:italic>Staphylococcus epidermidis<\/jats:italic>\n                      was homogenous with most of them belonging to CC2 (78.3%). Conversely, the genetic population of\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      was highly diverse. Resistance to first-line antibiotics was common among staphylococci, especially among CC5\n                      <jats:italic>S. aureus<\/jats:italic>\n                      . Methicillin-resistant\n                      <jats:italic>S. aureus<\/jats:italic>\n                      was commonly resistant to fluoroquinolones and azithromycin (78.6%) and tobramycin (57%). One-third of the CoNS were resistant to fluoroquinolones and 53% to azithromycin. Macrolide resistance was commonly caused by\n                      <jats:italic>erm<\/jats:italic>\n                      genes in\n                      <jats:italic>S. aureus<\/jats:italic>\n                      ,\n                      <jats:italic>mphC<\/jats:italic>\n                      and\n                      <jats:italic>msrA<\/jats:italic>\n                      in CoNS, and\n                      <jats:italic>mefA and msr(D<\/jats:italic>\n                      ) in streptococci. Aminoglycoside resistance in staphylococci was mainly associated with genes commonly found in mobile genetic elements and that encode for nucleotidyltransferases like\n                      <jats:italic>ant(4\u2032)-Ib<\/jats:italic>\n                      and\n                      <jats:italic>ant(9)-Ia<\/jats:italic>\n                      . Fluroquinolone-resistant staphylococci carried from 1 to 4 quinolone resistance-determining region mutations, mainly in the\n                      <jats:italic>gyrA<\/jats:italic>\n                      and\n                      <jats:italic>parC<\/jats:italic>\n                      genes. We found that GPB causing keratitis are associated with strains commonly resistant to first-line topical therapies, especially staphylococcal isolates that are frequently multidrug-resistant and associated with major hospital-adapted epidemic lineages.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.01247-23","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T09:01:38Z","timestamp":1706605298000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["Characterization of the resistome and predominant genetic lineages of Gram-positive bacteria causing keratitis"],"prefix":"10.1128","volume":"68","author":[{"given":"Camille","family":"Andr\u00e9","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew G.","family":"Van Camp","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawson","family":"Ung","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Gilmore","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2867-1450","authenticated-orcid":false,"given":"Paulo J. M.","family":"Bispo","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2017-311258"},{"key":"e_1_3_3_3_2","first-page":"1027","article-title":"Estimated burden of keratitis \u2014 United States, 2010","volume":"63","author":"Collier SA","year":"2014","unstructured":"Collier SA, Gronostaj MP, MacGurn AK, Cope JR, Awsumb KL, Yoder JS, Beach MJ, Centers for Disease Control and Prevention (CDC). 2014. Estimated burden of keratitis \u2014 United States, 2010. 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