Antibacterial resistance in ophthalmic infections: a multi-centre analysis across UK care settings

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Title: Antibacterial resistance in ophthalmic infections: a multi-centre analysis across UK care settings
Authors: Lee, A
Niruttan, K
Rawson, T
Moore, L
Item 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.
Editors: Cocks, O
Issue Date: 3-Sep-2019
Date of Acceptance: 27-Aug-2019
ISSN: 1471-2334
Publisher: BioMed Central
Journal / Book Title: BMC Infectious Diseases
Copyright Statement: This paper is embargoed until publication. Once published it will be available fully open access.
Keywords: 0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Publication Status: Accepted
Conference Place: UK
Embargo Date: publication subject to indefinite embargo
Article Number: INFD-D-19-00719
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