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    Stopping postop infection

    Identifying specific risk factors more effective approach rather than reacting to organisms

    Take-Home Message: Postoperative infections with ocular surgeries may be reduced substantially by effectively treating active ocular disease in advance before the patient enters the operating room.

    Miami—The ocular isolates that are most likely to be recovered in the United States from infections related to ophthalmic surgeries are predominantly gram-positive bacterial organisms, especially coagulase-positive and coagulase-negative staphylococci.

    These organisms are linked in upward of 95% of post-cataract infections with gram negative and fungal organisms being much less commonly implicated.

    “This trend to recovery of gram-positive organisms, while not new, is continuing, and studies over the past few years have documented the preponderance,” said Terrence P. O’Brien, MD, professor of ophthalmology, University of Miami, and co-director, Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Miami.

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    The most recent laboratory research has reinforced that no single antibiotic agent is universally effective for eradicating these bacteria and suggests that a combination of antibacterial agents may be more effective.

    However, turning one’s attention on the host, i.e., the patient, and identifying specific risk factors may be a more effective approach for beating these culprits of infection rather than reacting to the organisms—given their ability to rapidly evolve and become resistant to prevention as well as treatment.

    An alarming trend that has surfaced over the past several years is the evolving resistance seen among the ocular pathogens to commonly used antibiotics, especially fluoroquinolones, as well as other frequently prescribed antibiotics. Among the predominantly recovered gram-positive organisms, reduced susceptibility to the commonly used antibiotics is being observed, he noted.

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    Another unfortunate trend compounds this problem, according to Dr. O’Brien. Fewer new drugs are being investigated by fewer companies because of the daunting costs of research and development (R&D), he observed.

    “Compared with the golden age of R&D of antibiotics in the 1970s when multiple new agents were introduced every year, now the situation for drug development . . . to treat systemic as well as ocular infections is in marked contrast to that enjoyed four decades ago,” he said.

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