Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia.
Sydney Eye Hospital, Sydney, New South Wales, Australia.
Clin Exp Ophthalmol. 2024 Apr;52(3):258-275. doi: 10.1111/ceo.14377. Epub 2024 Mar 17.
Antimicrobial resistance (AMR) is a global public health threat with significant impact on treatment outcomes. The World Health Organization's Global Action Plan on AMR recommended strengthening the evidence base through surveillance programs and research. Comprehensive, timely data on AMR for organisms isolated from ocular infections are needed to guide treatment decisions and inform researchers and microbiologists of emerging trends. This article aims to provide an update on the development of AMR in ocular organisms, AMR in bacterial ocular infections and on AMR stewardship programs globally. The most common ocular pathogens are Pseudomonas aeruginosa, Staphylococcus spp., Streptococcus pneumoniae, and Haemophilus influenzae in ocular infections. A variety of studies and a few surveillance programs worldwide have reported on AMR in these infections over time. Fluoroquinolone resistance has increased particularly in Asia and North America. For conjunctivitis, the ARMOR cumulative study in the USA reported a slight decrease in resistance to ciprofloxacin. For keratitis, resistance to methicillin has remained stable for S. aureus and CoNS, while resistance to ciprofloxacin has decreased for MRSA globally. Methicillin-resistance and multidrug resistance are also emerging, requiring ongoing monitoring. Antimicrobial stewardship (AMS) programmes have a critical role in reducing the threat of AMR and improving treatment outcomes. To be successful AMS must be informed by up-to-date AMR surveillance data. As a profession it is timely for ophthalmology to act to prevent AMR leading to greater visual loss through supporting surveillance programmes and establishing AMS.
抗微生物药物耐药性（AMR）是对治疗结果具有重大影响的全球公共卫生威胁。世界卫生组织的 AMR 全球行动计划建议通过监测计划和研究来加强证据基础。需要全面、及时的眼部感染分离的微生物 AMR 数据来指导治疗决策，并为研究人员和微生物学家提供有关新出现趋势的信息。本文旨在提供眼部微生物 AMR 发展、细菌性眼部感染 AMR 以及全球 AMR 管理计划的最新信息。眼部感染中最常见的眼部病原体是铜绿假单胞菌、葡萄球菌属、肺炎链球菌和流感嗜血杆菌。随着时间的推移，世界各地的各种研究和少数监测计划已经报告了这些感染中的 AMR。氟喹诺酮类耐药性在亚洲和北美尤其增加。对于结膜炎，美国的 ARMOR 累积研究报告称，对环丙沙星的耐药性略有下降。对于角膜炎，金黄色葡萄球菌和凝固酶阴性葡萄球菌对甲氧西林的耐药性保持稳定，而全球耐甲氧西林金黄色葡萄球菌对环丙沙星的耐药性有所下降。耐甲氧西林和多药耐药性也在出现，需要持续监测。抗菌药物管理（AMS）计划在减少 AMR 威胁和改善治疗结果方面发挥着关键作用。AMS 要成功，就必须以最新的 AMR 监测数据为依据。作为一个专业，眼科及时采取行动预防 AMR 导致的视力丧失增加，通过支持监测计划和建立 AMS 来发挥作用。
