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    Antibiotic resistance in the eyecare practice

     

    Modern antibiotic resistance

    Staphylococcus aureus is recognized as having expert flexibility in the face of challenge. In the early 1960s, S. aureus was first recognized as being resistant to the favored antibiotic of the time, methicillin, and now we have methicillin-resistant S. aureus, or MRSA.3 S. aureus has been discovered in Egyptian mummies, and  MRSA was first found in 1961 in the U.K.

    Entering the 21st century, S. aureus and other bacterial groups have become resistant to methacillin and other classes of antibiotics, including the fluoroquinolones.4

    Current rising and alarming levels of multi-class antibiotic resistance of groups of bacteria are thought to be due to increased selective pressure from the overuse of antibiotics in medicine, agriculture, and veterinary medicine. Bacterial exposure to antibiotics in these settings generates microbial resistance that is transferred and spread through person-to-person contact, food, water, and other sources.

    The Centers for Disease Control (CDC) estimated in 2015 over two million infections in the U.S. were due to antibiotic-resistant organisms that culminated in over 23,000 deaths.5

    In May 2015, the World Health Assembly adopted the global action plan on antimicrobial resistance. One of the five strategic objectives of the action plan is to strengthen the evidence base through enhanced global surveillance and research in antibiotic resistance. The Global Antimicrobial Resistance Surveillance System (GLASS) is being launched to support a standardized approach to the collection, analysis, and sharing of data on antimicrobial resistance at a global level in order to inform decision-making; drive local, national, and regional action; and provide the evidence base for action and advocacy. GLASS aims to combine clinical, laboratory, and epidemiological data on pathogens that pose the greatest threats to global health.6

    Finding resistance in eye care

    Antibiotic resistance is present in eye care as well. One bug all too familiar to us is Pseudomonas aeruginosa. It causes keratitis and subsequent corneal ulcers and infiltrates. We see Pseudomonas infections related to contact lenses. There is a new species of Pseudomonas called multidrug-resistant Pseudomonas aeruginosa or MDR-PA.7-10

    MDR-PA is a superbug showing resistance to several antibiotics. When compared to Pseudomonas, MDR-PA is more virulent and results in poorer treatment outcomes.7 Corneal perforation, cyanoacrylate glue, and keratoplasty are more commonly required with MDR-PA vs. Pseudomonas.

    Contact lens wearers are not immune to antibiotic resistance. The rising tide of resistance can be seen in several cases of Pseudomonas ulcers related to contact lens wear.6 Because most ulcers are caused by Pseudomonas, MDR-PA is more common that you may think. Studies have shown the root cause of many antibiotic treatment failures is resistance.7-10

    In many cases, the initial regimen of antibiotics proved to be ineffective. Changing initial regimens from time to time is recommended as a step toward reducing resistance in Pseudomonas.8 Going outside the normal antibiotic realm for eye care is another option. As mentioned before, Colistin has been shown to be effective against superbugs, even those in eye care. But as already mentioned, new superbugs are resistant to Colistin.1 In one case, the dosing regimen was topical Colistin 0.19% every hour. It took 28 days of treatment to finally resolve. The scar remained even after one year of follow-up.10

    Katherine M. Mastrota, MS, OD, FAAO, Dipl ABO
    Director of Optometry, New York Hotel Trades Council, Hotel Association of New York City, Health Center, Inc.

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    Optometry Times A/V