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ARMOR data emphasizes need for ongoing surveillance, OD awareness
Relatively no change was seen from 2014 to 2015.
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Data from the Antibiotic Resistance Monitoring in Ocular Microorganism study show that high levels of antibiotic resistance continue among Staphylococcus, especially methicillin resistance, according to a poster presented at the Association of Research in Vision and Ophthalmology meeting.
The nationwide Antibiotic Resistance Monitoring in Ocular Microorganism (ARMOR) surveillance study is ongoing and specific to ocular pathogens. Christine Sanfilippo, PhD, and fellow researchers looked at preliminary data from 19 U.S. sites in 2015, and a total of 441 isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa and Haemophilus influenzae were collected and tested for antibiotic susceptibility.
Sanfilippo, who is manager of pharmaceutical medical affairs, Bausch + Lomb, told Primary Care Optometry News, “There’s relatively no change in overall trends from 2014. No change suggests eye care practitioners could be improving their antibiotic stewardship practices.”
The researchers wrote that nonsusceptibility rates for S. aureus and CoNS generally remained steady.
The highest level of resistance was found for azithromycin, at 54% to 59%, followed by oxacillin/methicillin, at 24% to 45%, and ciprofloxacin, at 22% to 28%. CoNS showed high nonsusceptibility rates to tobramycin and trimethroprim.
The 2015 preliminary ARMOR data show that one-fifth of S. aureus and more than one-third of CoNS isolates were nonsusceptible to three or more drug classes, and 67% of methicillin-resistant S. aureus (MRSA) and 74% of methicillin-resistant CoNS were resistant to multiple drugs.
“This research puts us in the position as prescribers to be more prudent when we choose antibiotics, which is true for orals and topicals, Glenn S. Corbin, OD, a private practitioner in Wyomissing, Pa., said in an interview with PCON. “Although it’s not routine to culture, we really need to look at this data to consider which drugs we want to employ for a particular case.”
Corbin said that doctors tend to automatically reach for a combination drug that includes an antibacterial for inflammatory conditions without infectious etiologies, “when the antibiotic component is not needed and only the steroid is necessary.”
He said this retrospective data makes a case for prescribing a steroid only if that is all you need.
“We contribute to the risk of resistance by prescribing the antibiotic when it’s unnecessary,” Corbin said.
S. pneumoniae isolates were found to still be susceptible to fluoroquinolones and chloramphenicol in the ARMOR study, but not to azithromycin (50%) and penicillin (38%). P. aeruginosa continues to exhibit low resistance, and H. influenzae remains susceptible to all antibiotics tested.
Sanfilippo said that doctors tend to have a drug of choice, “but if there is an increase in resistance, doctors may consider rotating antibacterial drugs and encourage patients to complete the full course of antibacterial drug prescribed.”
Corbin stressed that resistance is not focused solely on oral medications.
“We shouldn’t overlook the problem just because something is a topical, where there’s an opportunity for a serious consequence, like with corneal ulcers, for example,” he said. “We need to make sure to choose an antibiotic that doesn’t have a high degree of resistance, so that we don’t treat inappropriately or subclinically.”
Sanfilippo said the surveillance data is valuable, especially for regional trends, and also for comparison with susceptibility among systemic infections.
“The 2015 ARMOR data continue to highlight the concerns we should have as eye care practitioners, namely the continued multidrug resistance among staphylococci,” Joseph P. Shovlin, OD, FAAO, a member of the PCON Editorial Board and president-elect of the American Academy of Optometry, explained. “These data emphasize the ongoing need for continued surveillance.
“To date, we’ve had to deal with systemic concerns, including MRSA, and now we have to confront the troubling ophthalmic resistance patterns as well,” he added. “Empiric treatment has generally been the dogma, but now susceptibility information reigns key before initiating empiric treatment for infection.”
Prescribers must remain vigilant and be aware of agents that may no longer be effective today, “even with heavy dosing schedules,” Shovlin said. “Casual use of antibiotics among prescribers is also plaguing us on the susceptibility/resistance front. And, when one deems antibiotic usage for prophylaxis is appropriate, a sublethal dosage must be avoided.” – by Abigail Sutton and Nancy Hemphill, ELS, FAAO
- Reference:
- Sanfilippo C, et al. Antibiotic resistance profiles of ocular pathogens – An update from the 2015 ARMOR surveillance study. Presented at: Association for Research in Vision and Ophthalmology meeting; May 1-5, 2016; Seattle.
- For more information:
- Glenn S. Corbin, OD, can be reached at: drcorbin@wyoopto.com.
- Christine Sanfilippo, PhD, can be reached at: christine.sanfilippo@bausch.com.
- Joseph P. Shovlin, OD, FAAO, can be reached at: jpshovlin@gmail.com.
Disclosures: Corbin and Shovlin report no relevant financial disclosures. Sanfilippo is manager of pharmaceutical medical affairs for Bausch + Lomb, which sponsored the study.