There were only two significant changes observed in resistance rates over the 8-year study period; among S. aureus, the percentage of isolates resistant to oxacillin decreased significantly from 17.1% in 2009 to 11.6% in 2016 (P = 0.014) and ciprofloxacin resistance also decreased significantly from 17.1% in 2009 to 4.7% in 2016 (P = 0.001). No other longitudinal trends were observed for any other ocular species/antibiotic class combination.
The longitudinal nature of this study allowed for analysis of resistance trends over the 8-year study period. Contrary to the reported increase in antibiotic resistance observed among ocular bacteria in the years before 2009, and most notably for MR among staphylococci,25–27 , 57 there were no significant increases in resistance rates of any ocular bacterial species to the tested antibiotics in the current dataset, consistent with findings in the full ARMOR dataset. In fact, there was a small but significant decrease in in vitro resistance to oxacillin and ciprofloxacin among S. aureus pediatric isolates. Consistent with the decrease in MRSA prevalence over time that was observed in the current study, a previous retrospective analysis of S. aureus isolates from infections (not limited to any anatomical site, mostly skin and soft tissue) in over 39,000 pediatric patients found that oxacillin resistance declined from 41% in 2005 to 32% in 2014 (P < 0.001).58 Further longitudinal data are needed to determine whether this decreasing trend persists among pediatric ocular isolates. Nonetheless, the lack of any increases in resistance over time is a welcome finding, and one that hopefully will be sustained and even improved upon over coming years. To this end, careful adherence to treatment guidelines and implementation of antibiotic stewardship strategies such as those advocated by the Pediatric Infectious Diseases Society59 and the American Academy of Pediatrics60 may minimize antimicrobial resistance development among bacteria causing ocular infections. Empiric coverage against MRSA is encouraged by many experts as long as prevalence of the organism exceeds 10%–15%.61 , 62
The authors thank Thomas R. Sexton, PhD, Stony Brook University (Stony Brook, NY) for performing statistical analyses and funded by Bausch & Lomb Incorporated. The authors also thank Rachel Hathcock, RN, BSN, and Sandra Westra, PharmD of Churchill Communications (Maplewood, NJ) for providing writing and editorial assistance, also funded by Bausch & Lomb Incorporated.
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