Antibiotic therapy in the era of multiresistance

Pubblicato il

Friday, 30 June 2017

Argomento

Eye infections

Antibiotic resistance in the spotlight at SICSSO Congress 2017.

The report entitled 'Antibiotic therapy in the era of multiresistance', delivered at the 16th SICSSO Congress by Stefania Stefani, Professor of Microbiology at the Department of Biomedical and Biotechnological Sciences, University of Catania.
Antibiotic resistance is a very serious public health problem on a global level. In Europe, the mortality rate due to microbial resistance is around 25,000 per year, with a related increase in costs in terms of healthcare expenditure.
In particular, in Italy, the prevalence of multi-drug-resistant (MDR) bacterial strains is high, especially when considering MRSA (Methicillin-Resistant Staphylococcus Aureus) and gram-negative bacteria, such as Escherichia coli e Klebsiella pneumoniae.
This scenario also has an important impact on ocular infections, as shown in surveillance studies that have highlighted an increase in resistance reaching 50% for MRSA and 62% for CoNS (Coagulase negative Staphylococci), the main pathogens implicated in endophthalmitis and conjunctivitis.
Among the main causes leading to the selection and spread of multi-resistant bacterial isolates is the insufficient use of rapid molecular diagnostics and the tendency of clinicians to rely on empirical treatment, administering one or more antibiotics, without verifying the local epidemiology of resistance.
L'therapeutic appropriateness is the main step for effective infection management. This translates into the need for a clear distinction between prophylaxis and treatment of infections and the choice of appropriate dosage, route of administration and duration of treatment.
It is also crucial to assess the increase in resistance to commonly used antibiotics over the last decade, such as fluoroquinolones, whose resistance rate in MRSA isolates is about 72.3-85.8%.
Some 'old' molecules, on the other hand, appear to have retained their efficacy due to their limited use.
The netilmicin, for example, still shows susceptibility data unchanged over the past 20 years against the main strains responsible for ocular infections, including MRSA and MRSE, with values comparable only to cefuroxime and vancomycin, both of which are not available for topical use.
Antibiotic resistance requires early intervention. Certainly understanding the difference between 'empirical therapy' and 'appropriate therapy' and focusing on the pharmacological characteristics of available molecules are important steps in order to use antimicrobial agents responsibly for both the individual patient and the community as a whole.
This is the important thing 'take home message' of Prof. Stefani's lecture that the attentive audience of ophthalmologists present will be able to use to make responsible clinical choices.