Management Of Ocular Infections Research Articles

Emerging antimicrobial resistance and need for antimicrobial stewardship for ocular infections in India: A narrative review.

Patients with ocular infections are at increased risk of vision impairment and may require immediate medical care to preserve their vision. Management of ocular bacterial infections has evolved in recent years and includes a pragmatic selection of broad-spectrum antibiotics based on the causative bacteria. Nevertheless, the treatment of bacterial ocular infections is increasingly becoming a challenge, as the causative bacterium acquires resistance to antibiotics through intrinsic and acquired methods. From an Indian perspective, along with the challenges of antibiotic resistance, there are other factors such as lack of knowledge on epidemiology, and lack of data on local susceptibility patterns of ocular pathogens that have significant impact on the management of ocular infections. This narrative review summarizes the available knowledge on prescribing antibiotics for five common ocular infections in India. It further highlights the significance of the understanding of antimicrobial susceptibility patterns across India as a cornerstone to promote rational use of ocular antibiotics. This review indicates that large-scale antimicrobial resistance surveillance studies can facilitate the synchronization of ophthalmic antimicrobial prescription policies with local antibiotic resistance patterns. Further, establishment of an antimicrobial stewardship program in ophthalmology can potentially increase the efficacy of diagnostic tools, and implement earlier adoption of effective antibiotics. Overall, this review provides consolidated information and key considerations for treatment decision-making of common ocular infections in India.

Alteration in the Efficacy of in Vitro Vancomycin and Ceftazidime Prepared in Normal Saline Versus Balanced Salt Solution in the Management of Ocular Infections

Objective: The purpose of this review article is to highlight the efficacy of Vancomycin and Ceftazidime formulated in different solutions for ocular use in the management of microbiological Ocular infections varies.
 Methodology: To locate and assess all relevant literature, we employed systematic review as a search approach, utilizing punctilious and unambiguous methodologies. We initiated by stipulating key terms and selecting appropriate databases for your literature search. To find replicable and reportable publications from high-quality peer-reviewed journals, we used Google Scholar, PubMed, and Research Gate.
 Results: Ceftazidime precipitated at 37 degree Celsius, but not at room temperature, however it did not show any effect on the pH of the medium. In both the media of Normal Saline and Balanced Salt Solution, it precipitated on its own or when coupled with vancomycin. Ceftazidime was initially prepared in Balanced Salt Solution rather than Normal Saline, which resulted in further precipitation. Ceftazidime prepared in Normal Saline precipitated to 54% after 168 hours in the dialysis chambers, compared to 88% in Balanced Salt Solution. Ceftazidime synthesized in Normal Saline declined from an initial concentration of 137.5 to 73.4 µg/ml after 48 hours, while ceftazidime prepared in Balanced Salt Solution decreased to 6.3µg/ml. Vancomycin precipitation was inappreciable.
 Conclusion: Vancomycin did not precipitate in Normal Saline or Balanced Salt Solution, according to this systemic study. Regardless of the presence of vancomycin, ceftazidime precipitated, and it precipitated more expeditiously if it was produced in Balanced Salt Solution rather than Normal Saline.

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013-2019.

Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China.

Surveillance of the Activity of Aminoglycosides and Fluoroquinolones Against Ophthalmic Pathogens from Europe in 2010–2011

Purpose/Aim: Bacterial infections of the ocular surface are commonly treated empirically with broad spectrum antibiotics. Due to concerns over increasing antibiotic resistance, we evaluated current susceptibility patterns of the ocular bacterial pathogens in Europe.Materials and methods: Non-consecutive ocular isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa were collected in 2011 from centers in France, Germany, Italy, Poland, Slovak Republic, Spain, and the United Kingdom. Centers were asked to provide similar numbers of methicillin-susceptible and -resistant staphylococcal isolates. Minimum inhibitory concentrations were determined for fluoroquinolones (besifloxacin, ciprofloxacin, moxifloxacin), aminoglycosides (tobramycin, gentamicin, netilmicin), oxacillin, chloramphenicol and erythromycin. Isolates were categorized as susceptible, intermediate, or resistant according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria.Results: A total of 741 ocular isolates were obtained. Antibiotic resistance rates depended not only on the antibiotic and species, but also varied greatly by the country of origin. Resistance to ciprofloxacin, tobramycin, erythromycin, and to a lesser extent, chloramphenicol, was a concern for all staphylococci. Multidrug resistance was common among methicillin-resistant S. aureus (MRSA) and MRCoNS and isolates of S. pneumoniae, H. influenzae, and P. aeruginosa were frequently non-susceptible to erythromycin, beta-lactams, and ciprofloxacin/tobramycin, respectively. Resistance rates showed substantial differences among the seven countries tested. Fluoroquinolones and aminoglycosides showed differences in antibacterial potency and resilience toward the antibiotic resistance mechanisms.Conclusions: Methicillin-resistant staphylococcal isolates were frequently non-susceptible to a multitude of other antibiotics, making MRSA and MRCoNS a potentially significant concern. The broad range of resistance rates observed across Europe in this study confirms the importance of considering current local resistance patterns when antibacterial agents are chosen for empiric management of ocular infections.

Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics

This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections. Interpretive assessment. Literature review and interpretation. Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed. New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.

Eficacia del voriconazol en queratitis fúngica por Cándida Albicans

A 70-year-old woman, with a history of diabetes and persistent corneal ulceration, developed a severe keratitis caused by Candida albicans. It evolved rapidly to corneal perforation in spite of treatment with topical amphotericin B and oral itraconazole. An amniotic membrane transplant was performed as an emergency, associated with systemic administration of voriconazole. The infection was solved successfully, although the patient needed a penetrating keratoplasty to restore the corneal transparency. Fungal keratitis caused by Candida albicans usually follows an aggressive course and may simulate a bacterial aetiology. Voriconazole is a new antifungal drug that appears to be very effective in the management of ocular infections caused by many filamentous and levaduriform fungi.

Fluconazole in Management of Ocular Infections due to Curvularia

The aim of this study was to determine the efficacy of fluconazole in treatment of ocular infections due to Curvularia fungus. Four patients who had proven infection of the ocular structures with Curvularia were treated with fluconazole orally and/or topically for 15 to 21 days. Success of therapy was determined by symptomatic improvement of the patient's ocular status and/or negative results on repeated culture in 2 cases. The therapeutic response was good in all patients.

Ocular infections due to anaerobic bacteria.

The increased recovery of anaerobic bacteria in clinical infection has led to greater appreciation of these organisms in ocular infections. In studies that employed adequate method for recovery of anaerobes they were isolated from about a third of patients with conjunctivitis, half of the time in pure culture. The predominant recovered anaerobes were Clostridium spp., gram-negative anaerobic bacilli, and Peptostreptococcus spp. Anaerobic bacteria were also recovered from patients who wore contact lenses and developed conjunctivitis. Anaerobic bacteria were also reported in cases of keratitis. The most frequently recovered anaerobes were Propionibacterium spp., Peptostreptococcus spp., Clostridium spp., Prevotella spp., and Fusobacterium spp. The most frequently recovered anaerobes from dacryocystitis were Peptostreptococcus spp., Propionibacterium spp., Prevotella spp., and Fusobacterium spp. This review describes the microbiology, diagnosis and management of ocular infections due to anaerobic bacteria in children.