Update on the Epidemiology and Antibiotic Resistance of Ocular Infections.

PURPOSE

The purpose of this review is to provide an update on the epidemiology and current antibiotic-resistant threats in ophthalmology.

METHODS

Trends in frequency and antibiotic-nonsusceptible profiles during an 11 year-period (2005-2015) were evaluated and compared with the 5-year Antibiotic Resistance Monitoring in Ocular Microorganism (ARMOR) study.

RESULTS

Trends in the current review confirmed the continued high rates of fluoroquinolone nonsusceptbility circulating among ocular methicillin-susceptible , methicillin-susceptible , methicillin-resistant , and methicillin-resistant isolates as well as the detection of uncommon, but emerging resistance (<5%) for , group, , and . We documented significant differences in empirical fluoroquinolone and aminoglycoside coverage for the top three ocular pathogens (coagulase-negative staphylococci, , and ) in general and for corneal isolates between the Miami and the ARMOR studies. Collectively, the coverage for Miami was 74% versus 65.9% for ARMOR ( < 0.0001, 5.3674-10.8042) for ciprofloxacin and 95.9% versus 84.2% for aminoglycosides (gentamicin/tobramycin) ( < 0.0001, 9.9925-13.3974). Monotherapy coverage for ciprofloxacin and levofloxacin for the most recent 5 years (2011-2015) was 76.6% and 77.1%, respectively. Combination therapy with a fluoroquinolone and vancomycin and/or vancomycin and an aminoglycoside provided coverage for 99% and 98% of the isolates, respectively.

CONCLUSION

The etiology of ocular pathogens is patient, source, and geography specific. The true incidence and/or prevalence are unknown. Fluoroquinolone monotherapy as standard therapy for common ocular infections needs to be reassessed. Ophthalmologists must become proactive and join the crusade to develop practical and prudent strategies for the administration of topical antibiotics.