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    Living in a bacterial world


    When Halloween comes around each year the television networks advertise their many scary movie marathons. In these cinematographic masterpieces, shapely young women decide to walk around by themselves in the dark only to be attacked by chainsaw-wielding maniacs or by crazy men wearing hockey masks.

    Although I am personally not enamored of these films, they must meet an important need of my countrymen, considering that Hollywood spits out sequel after sequel.

    A related genre of film is that in which the people are attacked by some natural predator, such as great white sharks in the Atlantic Ocean (Jaws) or giant snakes in the Amazon River of Brazil (Anaconda).

    When I do watch these movies, having a pretty good idea that one or more of the protagonists are going to have something bad happen, the anticipation of the scary part results in a lot of boredom as the initial character development takes place.

    Is the giant man-eating snake about to leap out of the water and grab Ice Cube and J. Lo, or do I have wait before the screams and excitement begin? Is that knocking at the door simply the local farmer, or is it the deranged mass-murderer?

    Enter deadly super-bacteria

    Well, that is how I am starting to feel about the long-heralded arrival of all the deadly super-bacteria.

    I believe you know about these, as they are routinely given front-page attention on our newspapers and prominent coverage in television news. These are the germs that can’t be stopped, we are told, because they have developed resistance to all the antibiotics at our disposal.

    It’s just a matter of time, we have been told for at least a decade, before these malicious microbes make a mockery of modern medicine. According to the CDC, 2 million Americans now suffer infections each year from these bacteria, and 23,000 of us die.

    “So, where the heck are they?” ask many ophthalmologists.

    In my own personal experience, there have always been infections that are difficult to treat (e.g., acanthamoeba or fungal keratitis), but that was no less the case 20 years ago than it is today. Bacterial infections are not (in my humble opinion) particularly more a concern today than they were a decade or two ago.

    In a recent poll of Ophthalmology Times readers, we asked whether drug-resistant bacterial infections were a concern in their practices.

    • Fifty-nine percent of respondents described these “superbugs” as “not an issue.”
    • Eighteen percent reported them to be of minimal concern.
    • Only 23% reported that they had experienced a significant encounter or encounters with the dread antibiotic-resistant organisms.

    So, roughly 4 in 5 ophthalmologists are like the movie-goer with the tub of popcorn on his or her lap, waiting for the ax-wielding miscreant who never seems to make an appearance.

    Why the disconnect between the ominous warnings of these monstrous microorganisms and the experience of most ophthalmologists?

    Is it the case that these malignant microbes simply fall victim to the very high levels of antibiotics we ophthalmologists can deliver topically to the cornea with our drops or intravitreally with our injections—even if they measure as being resistant in the lab when tested against the very low antibiotic concentrations achievable in the bloodstream?

    Or, are we like the teenager in the movie who, lulled into a false sense of security, decides to go for a moonlight swim, unaware of the fin breaking the water’s surface yards behind us?




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    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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