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Ophthalmology in need of antimicrobial stewardship
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SAN DIEGO — Data recently presented at ICAAC 2015 suggest slower recovery and higher culture rates among microbial keratitis patients receiving antibiotic therapy.
These outcomes indicate areas in which antibiotic stewardship may benefit ophthalmologic practice, according to Darlene Miller, DHSc, MPH, research associate professor of ophthalmology and scientific director of the Ocular Microbiology Laboratory at the University of Miami.
“Ophthalmology is unique in that most of the dispensed antibiotics are empirical, and they are used to treat the most common ocular pathogens: keratitis and conjunctivitis,” Miller told Infectious Disease News. “Right now, we don’t have antibiotic stewardship in ophthalmology. The majority of the organisms are treated empirically, and are treated … after the initial therapy has failed.”
Miller and colleagues examined the efficacy and frequency of empirical antimicrobial therapy dispensed by ophthalmologists to 176 patients presenting to the ER for microbial keratitis from May to July 2014, and October to December 2014. The researchers reviewed laboratory records to determine positive culture rates, organism frequency, the type of drugs prescribed and whether an antibiotic was administered alone or in combination with others.
The researchers found that 52% of patients were administered antimicrobial therapy without a microbiological evaluation, of whom 92% were prescribed broad-spectrum antibiotics. Combination therapy was documented for 27% of patients, and gram-negative pathogens were the most common cause of community-associated microbial keratitis (48%).
There was a positive culture rate of 44% for all patients, but the rate was higher among those given antibiotics (51.9% vs. 36%). In addition, patients who were not given antibiotics had a greater chance of recovery within 48 hours (90% vs. 66%) than those treated empirically. Moreover, fungal pathogens (Fusarium species, 67%) and MRSA (100%) were more frequently recovered from patients on combination therapy.
According to Miller, these outcomes demonstrate the need for stewardship interventions in the field of ophthalmology, especially in regard to antibiotic selection, dispensing, dosing and duration.
“Antibiotic resistance in ophthalmology is a part of the growing problem in global antibiotic resistance, and it is a contributing factor to patient failure in health care,” Miller said. “We need to bring all settings into the discussion on antibiotic resistance and patient care in the United States and globally.” – by Dave Muoio
Reference:
Miller D, et al. Abstract S-920. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: Miller reports no relevant financial disclosures