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

Abstract

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.

The landscape of bacterial antibiotic susceptibility in a multi-tier ophthalmology network in India: an electronic medical record driven analytics report

“…AST is an important part of the targeted antibiotic-prescribing process for bacterial diseases, helping to cope with and reduce the growing emergence and spread of antimicrobial resistance (AMR), informing on the success of infection control measures and ultimately saving the lives of patients. The widespread and injudicious use of conventional antibiotics in ocular infections, together with improper dosing regimen, pharmaceutical compliance, and the absence of global ocular antibiotic prescription guidelines have resulted in AMR among Gram-positive and Gram-negative bacteria [13]. There is an urgent need for a robust national AMR surveillance system in India, along with a programme for AMR containment and antimicrobial stewardship programmes in both hospitals and the community.…”

Antimicrobial resistance in ocular infection: A review

“…External factors are vastly influenced by humans including excessive consumption of broad-spectrum antibiotics; inappropriate antibiotic dosage; poor patient compliance, inappropriate antibiotic use for veterinary and agricultural purposes; inappropriate disposal of antibiotics; lack of effective strategies for prevention of transmission of resistant bacteria in healthcare centres; and use of substandard antibiotics. [13][14][15][16] 3.1 | Intrinsic antimicrobial resistance Bacteria may have a natural resistance to antibiotics which may be intrinsic or induced. Intrinsic antimicrobial resistance is a trait shared within the bacterial species regardless of their previous exposure to an antibiotic and it is not related to horizontal gene transfer (HGT).…”

“…16 The WHO Global Action Plan in 2015 aimed to enhance awareness and understanding of AMR and strengthen knowledge through surveillance and research. 5,16 Indeed, AMS have reduced AMR hospital related infections and health care costs. 16,110,111 The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System was established in 2013.…”

“…5,16 Indeed, AMS have reduced AMR hospital related infections and health care costs. 16,110,111 The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System was established in 2013. This system has provided local and national trends in antimicrobial use and AMR to clinicians, policymakers, and health care managers to inform clinical practice and policy development.…”

Commentary: Fluoroquinolone resistance in bacterial isolates from ocular infections: Trend in antibiotic susceptibility patterns between 2005-2020

“…It leads to longer hospital stays, higher medical costs, and increased mortality. [ 2 ] In adults, the most common cause for corneal blindness is infectious keratitis. [ 3 ] Ocular infections are a major cause of visual impairment and blindness.…”