Bacterial Ocular Surveillance System (BOSS) Sydney, Australia 2017-2018

Authors

  • 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

DOI:

https://doi.org/10.33321/cdi.2020.44.86

Keywords:

Antibiotic resistance, bacterial keratitis, corneal scrape, surveillance

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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Published

25/11/20

How to Cite

Watson, Stephanie L., Barrie J Gatus, Maria Cabrera-Aguas, Benjamin H Armstrong, CR Robert George, Pauline Khoo, and Monica M Lahra. 2020. “Bacterial Ocular Surveillance System (BOSS) Sydney, Australia 2017-2018 ”. Communicable Diseases Intelligence 44 (November). https://doi.org/10.33321/cdi.2020.44.86.

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Vol. 44 (2020)

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