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Watson SL, Gatus BJ, Cabrera-Aguas M, Armstrong BH, George CR, Khoo P, Lahra MM. Bacterial Ocular Surveillance System (BOSS) Sydney, Australia 2017-2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 33278871 DOI: 10.33321/cdi.2020.44.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract This study investigated antimicrobial resistance (AMR) profiles from a cohort of patients with bacterial keratitis treated at Sydney Eye Hospital, 1 January 2017 - 31 December 2018. These AMR profiles were analysed in the context of the current Australian empiric regimens for topical therapy: ciprofloxacin/ofloxacin monotherapy versus combination therapy of cefalotin/cephazolin plus gentamicin. At our Centre, combinations of (i) chloramphenicol plus gentamicin and (ii) chloramphenicol plus ciprofloxacin are alternatively used, so were also analysed. Three hundred and seventy-four isolates were cultured prospectively: 280/374 (75%) were gram positive, and 94/374 (25%) were gram negative. Coagulase-negative staphylococci comprised 173/374 (46%). Isolates included Staphylococcus aureus (n = 43/374) 11%; Streptococcus pneumoniae (n = 14/374) 3.7%; and Pseudomonas aeruginosa (n = 50/374) 13%. Statistical comparison was performed. There was no significant difference between cover provided either of the current Australian recommendations: ciprofloxacin/ofloxacin vs cefalotin/cephazolin plus gentamicin (5.3% vs 4.8%, respectively; p = 0.655). However, the combination of chloramphenicol plus an anti-pseudomonal agent (ciprofloxacin/ofloxacin or gentamicin) had significantly improved cover. Chloramphenicol plus gentamicin was superior to ciprofloxacin/ofloxacin (1.9% vs 5.3% resistance respectively; p = 0.007), and cefalotin/cephazolin plus gentamicin (1.9% vs 4.8%; p = 0.005). Chloramphenicol plus ciprofloxacin was superior to ciprofloxacin/ofloxacin monotherapy (1.3% vs 5.3%; p ≤ 0.001), and to cefalotin/cephazolin plus gentamicin (1.3% vs 4.8%; p = 0.003). Chloramphenicol plus gentamicin versus chloramphenicol plus ciprofloxacin/ofloxacin were equivalent (p = 0.48). There was no demonstrated in vitro superiority of either the current empiric antibiotic regimens. For our setting, for bacterial keratitis, chloramphenicol in combination offered superior in vitro cover. Broadened surveillance for ocular AMR is urgently needed across jurisdictions.
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Affiliation(s)
- Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Barrie J Gatus
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
| | - Maria Cabrera-Aguas
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Benjamin H Armstrong
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
| | - Cr Robert George
- NSW Health Pathology Microbiology John Hunter Hospital, NSW, Australia
| | - Pauline Khoo
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Monica M Lahra
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
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Croghan C, Lockington D. Management of MRSA-positive eye swabs and the potential advantages of chloramphenicol availability in the United Kingdom. Eye (Lond) 2017; 32:157-159. [PMID: 29192680 DOI: 10.1038/eye.2017.257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- C Croghan
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland
| | - D Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland
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Pearce F, Wong N, Chan E. Incidence of chloramphenicol use and the effect on corneal scrape results in bacterial keratitis. Clin Exp Ophthalmol 2016; 44:868-869. [PMID: 27549348 DOI: 10.1111/ceo.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona Pearce
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Nathan Wong
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Elsie Chan
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
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