Antibiotic resistance in ocular infections
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Prevalence and Trends of Antibiotic Resistance in Ocular Infections
Antibiotic resistance is a significant and growing concern in the treatment of ocular infections. Surveillance studies in the United States and globally have consistently found high rates of resistance among common ocular pathogens, especially Staphylococcus aureus and coagulase-negative staphylococci (CoNS) Thomas2019Haas2011Cabrera-Aguas2024+3 MORE. Methicillin resistance is particularly prevalent, with rates ranging from about 36% to nearly 50% for S. aureus and CoNS, respectively Thomas2019Asbell2015. Multidrug resistance (MDR), defined as resistance to three or more antibiotic classes, is also common among methicillin-resistant strains, with up to 86% of methicillin-resistant S. aureus (MRSA) and 77% of methicillin-resistant CoNS (MRCoNS) showing MDR Thomas2019Asbell2015Bispo2022.
Resistance Patterns by Pathogen and Antibiotic Class
Staphylococcus aureus and Coagulase-Negative Staphylococci
Both S. aureus and CoNS frequently show resistance to methicillin, fluoroquinolones, macrolides, and aminoglycosides Thomas2019Haas2011McDonald2010+3 MORE. Methicillin-resistant isolates are much more likely to be resistant to multiple other antibiotic classes Thomas2019Haas2011Asbell2015+1 MORE. While some studies have noted a slight decrease in methicillin resistance over recent years, the overall prevalence remains high and is especially pronounced in older patients Thomas2019Asbell2015Deguchi2018+1 MORE.
Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa
Resistance among S. pneumoniae is highest for macrolides such as azithromycin, but remains lower for other antibiotic classes Thomas2019Haas2011Asbell2015. H. influenzae and P. aeruginosa generally show low resistance rates to most antibiotics, though there are regional variations and occasional reports of emerging resistance Thomas2019Haas2011Miller2017+2 MORE. For P. aeruginosa, resistance to ciprofloxacin, gentamicin, and ceftazidime is generally low but can be higher in some countries, with resistance to ciprofloxacin reported as high as 33% in certain regions .
Corynebacterium
In Japan, more than half of Corynebacterium isolates from ocular infections remain resistant to fluoroquinolones, with little change over a decade, highlighting the need for cautious use of these drugs .
Geographic and Demographic Variations
Resistance rates can vary by region and patient demographics. For example, higher rates of methicillin resistance have been observed in elderly patients and in certain geographic areas, such as the southern United States Thomas2019Asbell2015. Local studies may show different antibiotic coverage rates compared to national surveillance data, emphasizing the importance of regional surveillance Miller2017Bispo2022.
Impact of Antibiotic Use and Stewardship
The emergence of resistance in ocular pathogens is linked to both systemic and topical antibiotic use McDonald2010Cabrera-Aguas2024Sharma2011. Overuse and inappropriate prescribing of antibiotics contribute to the development of resistance. Newer antibiotics, such as besifloxacin, developed exclusively for ophthalmic use, may help reduce selective pressure for resistance McDonald2010Sharma2011. Antimicrobial stewardship programs, informed by up-to-date surveillance data, are critical for guiding appropriate antibiotic use and reducing the threat of resistance .
Surveillance and Future Directions
Ongoing surveillance programs like the ARMOR study are essential for tracking resistance trends and informing empirical treatment choices Thomas2019Cabrera-Aguas2024Asbell2015+1 MORE. While some decreases in resistance have been observed for certain antibiotics, the continued high prevalence of methicillin and multidrug resistance among staphylococci underscores the need for vigilance and prudent antibiotic use Thomas2019Cabrera-Aguas2024Asbell2015+2 MORE.
Conclusion
Antibiotic resistance in ocular infections is a persistent and evolving challenge, particularly among staphylococcal species. High rates of methicillin and multidrug resistance demand careful antibiotic selection and highlight the importance of surveillance and stewardship efforts. Continued monitoring and judicious use of antibiotics are essential to preserve treatment effectiveness and prevent further resistance development.
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