Antibacterial resistance in ophthalmic infections: a multi-centre analysis across UK care settings
File(s)
Published version
Author(s)
Lee, Alice
Niruttan, Kanchana
Rawson, Tim
Moore, Luke
Type
Journal Article
Abstract
Background: Bacterial ophthalmic infections are common. Empirical treatment with topical broad-spectrum antibiotics is recommended for severe cases. Antimicrobial resistance (AMR) to agents used for bacterial ophthalmic infections make it increasingly important to consider changing resistance patterns when prescribing, however UK data in this area are lacking. We evaluate the epidemiology and antimicrobial susceptibilities of ophthalmic pathogens across care settings and compare these with local and national antimicrobial prescribing guidelines.
Methods: A retrospective, multi-centre observational analysis was undertaken of ophthalmic microbiology isolates between 2009-2015 at a centralised North-West London laboratory (incorporating data from primary care and five London teaching hospitals). Data were analysed using descriptive statistics with respect to patient demographics, pathogen distribution (across age-groups and care setting), seasonality, and susceptibility to topical chloramphenicol, moxifloxacin, and fusidic acid.
Results: 2681 isolates (n=2168 patients) were identified. The commonest pathogen in adults was Staphylococcus spp. across primary, secondary, and tertiary care (51.7%; 43.4%; 33.6% respectively) and in children was Haemophilus spp. (34.6%;28.2%;36.6%). AMR was high and increased across care settings for chloramphenicol (11.8%;15.1%;33.8%); moxifloxacin (5.5%;7.6%;25.5%); and fusidic acid (49.6%;53.4%; 58.7%). Pseudomonas spp. was the commonest chloramphenicol-resistant pathogen across all care settings, whilst Haemophilus spp. was the commonest fusidic acid-resistant pathogen across primary and secondary care. More isolates were recorded in spring (31.6%) than any other season, mostly due to a significant rise in Haemophilus spp.
Conclusions: We find UK national and local antimicrobial prescribing policies for ophthalmic infections may not be concordant with the organisms and antimicrobial susceptibilities found in clinical samples. We also find variations in microbial incidence related to patient age, clinical setting, and season. Such variations may have further important implications for prescribing practices and modification of antimicrobial guidelines.
Methods: A retrospective, multi-centre observational analysis was undertaken of ophthalmic microbiology isolates between 2009-2015 at a centralised North-West London laboratory (incorporating data from primary care and five London teaching hospitals). Data were analysed using descriptive statistics with respect to patient demographics, pathogen distribution (across age-groups and care setting), seasonality, and susceptibility to topical chloramphenicol, moxifloxacin, and fusidic acid.
Results: 2681 isolates (n=2168 patients) were identified. The commonest pathogen in adults was Staphylococcus spp. across primary, secondary, and tertiary care (51.7%; 43.4%; 33.6% respectively) and in children was Haemophilus spp. (34.6%;28.2%;36.6%). AMR was high and increased across care settings for chloramphenicol (11.8%;15.1%;33.8%); moxifloxacin (5.5%;7.6%;25.5%); and fusidic acid (49.6%;53.4%; 58.7%). Pseudomonas spp. was the commonest chloramphenicol-resistant pathogen across all care settings, whilst Haemophilus spp. was the commonest fusidic acid-resistant pathogen across primary and secondary care. More isolates were recorded in spring (31.6%) than any other season, mostly due to a significant rise in Haemophilus spp.
Conclusions: We find UK national and local antimicrobial prescribing policies for ophthalmic infections may not be concordant with the organisms and antimicrobial susceptibilities found in clinical samples. We also find variations in microbial incidence related to patient age, clinical setting, and season. Such variations may have further important implications for prescribing practices and modification of antimicrobial guidelines.
Editor(s)
Cocks, Oliver
Date Issued
2019-09-03
Date Acceptance
2019-08-27
Citation
BMC Infectious Diseases, 2019, 19, pp.1-8
ISSN
1471-2334
Publisher
BioMed Central
Start Page
1
End Page
8
Journal / Book Title
BMC Infectious Diseases
Volume
19
Copyright Statement
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
Identifier
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4418-0
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Ophthalmology
Infectious diseases
Microbiology
Conjunctivitis
Antimicrobial resistance
Antimicrobial stewardship
Topical antimicrobials
Eye infections
BACTERIAL ENDOPHTHALMITIS
CHLORAMPHENICOL
CONJUNCTIVITIS
MICROBIOLOGY
EYE
Antimicrobial resistance
Antimicrobial stewardship
Conjunctivitis
Eye infections
Infectious diseases
Microbiology
Ophthalmology
Topical antimicrobials
0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Microbiology
Publication Status
Published
Coverage Spatial
UK
Article Number
768
Date Publish Online
2019-09-03