Systematic Review: Multi-decade Antibiotic Resistance of Ocular Bacteria in the U.S.
Key findings
- This analysis compared 25 years of localized U.S. studies of antibiotic susceptibility specific to ocular bacterial pathogens with the first 10 years of data from the nationwide Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study
- Across all studies, there was high in vitro resistance to fluoroquinolones, macrolides and methicillin/oxacillin among staphylococci, and multidrug resistance was prevalent among methicillin-resistant staphylococci
- S. pneumoniae was generally highly susceptible to fluoroquinolones, chloramphenicol, and tetracycline; P. aeruginosa to fluoroquinolones and aminoglycosides and H. influenzae to fluoroquinolones, macrolides, and chloramphenicol
- ARMOR 10-year cumulative susceptibility data were generally mid-range of, or similar to, localized susceptibility data
- These findings validate the use of ARMOR data when choosing empiric therapy if local antibiotic susceptibility data are unavailable
In 2009, Bausch & Lomb began sponsoring the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR), a U.S. laboratory study that surveils common ocular bacterial pathogens. Predefined numbers of ocular isolates are obtained annually from hospitals, specialty centers, and reference laboratories nationwide.
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Paulo Bispo, PhD, of the Department of Ophthalmology at Mass Eye and Ear/Massachusetts General Hospital, and colleagues found the first 10 years of ARMOR data were generally consistent with 25 years of local and regional U.S. data. Their systematic review, published in Ophthalmology and Therapy, supports relying on ARMOR findings when choosing empiric therapy if local antibiotic susceptibility data are unavailable.
Figure 1
Paulo Bispo, PhD, (right) working in his Mass Eye and Ear laboratory with medical student Jadesola (Jade) Oremosu.
Methods
The team searched MEDLINE, EMBASE, and BIOSIS Previews for local and/or regional studies of in vitro antibiotic susceptibility of common ocular pathogens published between January 1, 1995, and June 30, 2021. They identified 32 relevant papers and compared the findings against those obtained in the ARMOR study between 2009 and 2018.
The primary focus was cross-study antibiotic susceptibility patterns for Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae, the bacterial pathogens that are specifically collected in ARMOR.
Antibiotic Susceptibility
Across all studies:
- S. aureus and CoNS showed high levels of in vitro resistance to fluoroquinolones, macrolides, and methicillin/oxacillin
- Methicillin-resistant S. aureus (MRSA) generally had low rates of susceptibility to fluoroquinolones and macrolides but was reasonably susceptible to chloramphenicol, tetracycline, trimethoprim, and vancomycin
- Data on multidrug resistance was scarce, but multidrug resistance was clearly prevalent among MRSA
- S. pneumoniae was generally highly susceptible to fluoroquinolones, chloramphenicol, and tetracycline; P. aeruginosa to fluoroquinolones and aminoglycosides; and H. influenzae to fluoroquinolones, macrolides, and chloramphenicol
- ARMOR 10-year cumulative susceptibility data were generally mid-range of, or similar to, other susceptibility data
Suggestion of Decreasing Resistance
Resistance of S. aureus to multiple antibiotic classes increased in the 1990s and into the 2000s. However, more recent data suggest a plateau and perhaps even decreasing resistance, most notably for methicillin/oxacillin. This trend might reflect the value of improved antibiotic stewardship.
Beyond the ARMOR study, there were few or no data available on trends in resistance of the other pathogens.
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