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    Antibiotic resistance in the eyecare practice


    Specifically related to eye care, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study is the only ongoing nationwide antibiotic resistance surveillance program specific to ocular pathogens.11 The ARMOR study reported resistance rates and trends among common ocular isolates collected during 2009-2013. Clinical centers across the U.S. submitted ocular isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa. A total of 3,237 ocular isolates were collected from 72 centers.

    Methicillin resistance was found among 42.2 percent of S. aureus isolates. Note that this MRSA resistance level increased from 29.5 percent in 2000 and 41.6 percent in 2005.12 Methicillin-resistant (MR) isolates had a high probability of concurrent resistance to fluoroquinolones, aminoglycosides, or macrolides. Multidrug resistance to at least three additional antibiotic classes was found in 86 percent of MR S. aureus isolates. Staphylococcal isolates from elderly patients were more likely to be MR, as were S. aureus isolates obtained from the southern United States. Although methicillin resistance among staphylococci in ocular isolates did not increase during the five-year study period, overall levels of multi-drug resistance is of serious concern.

    These findings are consistent with resistance trends reported for nonocular staphylococcal isolates.11 Continued surveillance of ocular isolates provides critical information to guide selection of topical antibacterials used for empirical management of ocular infections.

    Clinicians should remain vigilant for patients at heightened risk for ocular MRSA colonization/infection. Risk factors include increasing age, increasing healthcare exposure, systemic disease, pre-existing ocular surface disorder,13 and long-term use of antibiotics or steroids.

    Preventing antibiotic resistance

    Several strategies have been laid out to combat resistance. A comprehensive strategy goes beyond just the prescriber. It encompasses education to the public, farming guidelines, and political and research goals.

    For the prescriber, better diagnostics are needed to differentiate among causes of infection. Not every red eye is bacterial and should be treated appropriately. Differentials are needed among bacterial, viral, and allergic conjunctivitis. Lab testing is very helpful in targeting the proper antibiotics to use. Indiscriminately using broad-spectrum antibiotics contributes to the resistance profile. Hygiene, hand-washing, and disinfection are very important practices to instill and continue to instill. Much of the transmission can be attributed to poor hygienic procedures.14 Also mentioned previously are changing initial regimens periodically and using antibiotics outside the norm when needed.

    For our patients and the public, education on proper use is important. Instructing patients to follow the prescription as directed needs constant review. The rationale for taking the antibiotic for the full course, instead of “saving” the pills for a later time needs emphasis. Using antibiotics on a chronic basis nullifies its anti-microbial abilities. There are exceptions—some antibiotics (such as doxycycline) are purposely prescribed for chronic use for anti-inflammatory, not anti-microbial, effects. Again, hand washing and hygiene are important guidelines to reinforce for patients and the public.14

    Strategies with regard to political policy and research and new antibiotics need to be discovered. Politicians can aid simplification of the complicated requirements for new drug approvals. Tax breaks and financial incentives can be offered for new antibiotic drug discoveries. Researchers can create better ways to monitor antibiotic resistance and identify new drug targets. Finally, use of antibiotics in farming and cattle/poultry raising can be reduced or modified.14

    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