Understanding Antibiotic Resistance

Ophthalmology Times wants insight on antibiotics and eye infections from clinicians in the field - so the editors asked you. Readers like you helped by completing our survey and telling us about your experience with postoperative infections after eye surgery, if you use topical antibiotic prior to cataract surgery, how you choose antibiotics in a routine surgical prophylaxis, and more. The 118 U.S.-based ophthalmologists who responded were entered into a drawing to win a $200 gift card, with the winner being an ophthalmologist in Houston.

Antibiotic resistance against fluoroquinolones is increasing, and that may adversely impact patients with retinal disorders. The introduction of intravitreal injections (IVT) to treat retinal diseases has increased from about 1 million in 2007 to an expected 6 million in 2016 (up from only 4,000 in 2001).

Ophthalmology Times asked readers for insights on antibiotics and eye infections from clinicians in the field - including experience with postoperative infections after eye surgery, if you use topical antibiotic prior to cataract surgery, how you choose antibiotics in a routine surgical prophylaxis, and more. The 118 U.S.-based ophthalmologists who responded were entered into a drawing to win a $200 gift card. Here are the survey results.

Descemet’s stripping automated endothelial keratoplasty (DSAEK) appears to have a higher risk of postoperative fungal infections (predominantly Candida) when compared to penetrating keratoplasty (PK).

Eye surgeons should use intracameral antibiotics only in select situations; they should avoid aminoglycosides, and they should not use vancomycin as prophylaxis. Michael Jumper, MD, offered this perspective as part of an overview of antibiotics used in intraocular surgery during the Glaucoma Symposium at the 2017 Glaucoma 360 meeting.

New treatment possibilities for nonresponsive bacterial keratitis are continually in development, including molecular-targeted therapy, the cautious use of topical corticosteroids, corneal crosslinking for superficial keratitis, and biologicals, Eduardo C. Alfonso, MD, reported.

A recent study sponsored by the National Eye Institute (NEI) of the optimal treatments for fungal keratitis showed that topical natamycin is still the mainstay of treatment. Adding oral voriconazole to the treatment regimen also may be beneficial to treat patients with Fusarium species.

What is the most common bacteria on the conjunctiva and lid margin in patients undergoing cataract surgery? An article in Clinical Ophthalmology may have the answer.

Practice patterns by oculoplastic surgeons for the use of antibiotics with eyelid surgery vary. Surgeons may overestimate the helpfulness of antibiotics.

Infectious keratitis is not a common complication after laser vision correction (LVC), but it is important because it can be devastating, said Deepinder K. Dhaliwal, MD, at Refractive Surgery Subspecialty Day 2016.

Watch as Regis Kowalski, Executive Director, The Charles T. Campbell Laboratory at the University of Pittsburgh, explains how newly discovered resurgent isolates may affect clinical practice.

Watch as Penny Asbell, MD, talks about antibiotic resistance in a webinar titled: The ARMOR Study Five-Year Surveillance Results.

Watch as Ben Wucher, researcher at University of Rochester Medical Center, summarizes his research titled, "Clinical keratitis isolates of Pseudomonas aeruginosa develop resistant biofilms."

In the most recent update from the ARMOR study, Penny Asbell, MD, FACS, MBA, explained that clinicians must choose their antibiotics carefully.

Postoperative endophthalmitis remains a potentially devastating complication of cataract surgery. However, a good visual outcome is possible if the infection is recognized early and treated appropriately, said Harry W. Flynn Jr, MD.

Steve Arshinoff, MD, FRCSC, of the University of Toronto, outlines the proper dosage and administration technique for intracameral moxifloxacin during cataract surgery.

In vitro antibiotic resistance-defined as the ability for bacteria to exist and multiply despite a normally achievable serum level of drug that had been previously determined to successfully treat a clinical infection-is an increasing problem worldwide.

Postoperative infections with ocular surgeries may be reduced substantially by effectively treating active ocular disease in advance before the patient enters the operating room.

The latest surveillance data on antibiotic resistance trends show increased levels of resistance among certain isolates, warranting ongoing, prospective, multicenter surveillance studies.

Perioperative intracameral antibiotics should be standard practice during cataract surgery to prevent postoperative endophthalmitis.

Understanding why ophthalmologists should be using intracameral antibiotics to lower the risk of postoperative endophthalmitis after cataract surgery.