Antibiotic therapy in the multi-drug resistance era

SICCSO XVI Congress, Grosseto (Tuscany - Italy), 22nd June 2017, h. 16.30-18.00 Session dedicated to the Infections 

Antibiotic-resistance is a serious problem of global public health. In Europe, the annual mortality rate due to resistant-pathogens is about 25,000 people, with a corresponding increase of the healthcare associated-costs. In particular, in Italy the spread of multi-drug resistant (MDR) strains is high, especially when looking at methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative pathogens, such as Escherichia coli and Klebsiella pneumoniae. This scenario affects also ophthalmological infections, as demonstrated by surveillance studies that have highlighted an increase in resistance reaching 50% for MRSA and 62% for negative Coagulase Staphylococci (CoNS), mainly involved in endophthalmitis and conjunctivitis.
Among the main causes leading to the selection and spread of MDR isolates there are the insufficient usage of rapid molecular diagnostic testing and the tendency of clinicians to rely on empirical treatment for MDR infections by administrating two or more antibiotics, without assessing the local epidemiology of resistance.
Therapeutic appropriateness is the first step to effectively manage infections due to MDR pathogens. In ophthalmology, clinical decision-making should be assessed on focusing the goal of the therapy, for example distinguishing between pre- and post-operative prophylaxis or acute infection treatment, and on tailoring the dosage, the route and the duration of therapy specifically to the ocular infection. Also, it is crucial to evaluate the increased resistance patterns to commonly used antibiotics during the last decade, as fluoroquinolones, whose percentage of resistance in MRSA isolates is around 72.3-85.8%. Yet, due to their limited use, some “old” molecules are still effective. Netilmicin, for example, still shows unchanged susceptibility data over the last 20 years towards the major strains responsible for eye infections, including MRSA and MRSE with values comparable only to cefuroxime and vancomycin, both not topically used.
Antibiotic resistance requires timely actions; certainly understanding the difference between empiric and appropriate therapy and focusing on the pharmacodynamics and the efficacy of the antibiotic at the site of infection, are important considerations to use antimicrobial agents in a responsible way for both the individual patient and the community.

Prof. Stefania Stefani
Department of Biomedical and Biotechnological Sciences
University of Catania – Italy

Dr. Carmelo Chines
Direttore responsabile

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