Update on Antimicrobial Resistance and Ocular Isolates
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OCULAR INFECTIONS (BH JENG, SECTION EDITOR)
Update on Antimicrobial Resistance and Ocular Isolates Prashant Garg • Aravind Roy
Published online: 30 August 2013 Springer Science + Business Media New York 2013
Abstract The phenomenon of ‘‘Antimicrobial Resistance (AMR)’’ is as old as the era of antibiotics. However, currently, it is posing a serious challenge in the management of various infectious diseases including ocular infections. Realizing the seriousness of the problem, the World Health Organization and other health agencies have adopted several programs to contain the menace. The surveillance of AMR is an essential part of the action plan and has contributed significant knowledge in this field. In the last decade, three nationwide surveillance studies from United States addressed AMR among ocular isolates. These studies indicate that AMR in ocular infections shows trends similar to systemic infections. Realizing the value of surveillance studies, there is a need to conduct similar studies in other parts of the world because AMR trends demonstrate regional variations. Further, there is enough evidence to suggest that prolonged and recurrent use of topical antibiotics in ophthalmology can result in colonization of the ocular surface by resistant organisms. Keywords Antimicrobial resistance Methicillin resistance Multi-drug resistance Ocular TRUST Antimicrobial resistance surveillance
Introduction The era of antibiotics for the management of serious and often deadly infections caused by bacteria began with the
P. Garg (&) A. Roy Cornea and Anterior Segment Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad 500 034, India e-mail: [email protected]
discovery of penicillin in 1928 by Alexander Fleming. The euphoria for this discovery was so much that, in 1944 when penicillin was introduced to general clinical practice, the term ‘‘Miracle Drug’’ entered the common vernacular. By 1965, physicians and scientists felt that bacterial diseases and the microbes responsible were no longer of great concern. Unfortunately, it did not take too long for them to realize the existence of resistant bacteria [1–3], and by 1980, fewer than 10 % of all clinical Staphylococcus cases could be cured by penicillin—a dramatic shift from the almost 100 % susceptibility of Staphylococcus in 1952 [4, 5]. To overcome this phenomenon of antibiotic resistance, scientists developed newer molecules with modified mechanisms of action. Little attention was paid to the seriousness and long-term consequences of Antimicrobial Resistance (AMR). Over a period of time, bacteria causing common infections have developed resistance to each new antibiotic, and today AMR has evolved to become a worldwide health threat and a critical issue [6••, 7, 8]. Although AMR is a public health concern primarily for diseases such as malaria, tuberculosis and to some extent HIV, it is also becoming increasingly important for some of the common bacterial diseases [9]. Organisms such as methicillin-resistant Staphylococc
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