Evidence based use of antibiotics in epidemic keratoconjunctivitis to prevent development of microbial resistance

Abstract

Aim: It was thought that resistance acquired during treatment of systemic diseases can lead to resistant bacteria in eye infections. However, evidences are showing emergence of bacterial resistance owing to prior topical antibiotic usage. In the current study, we intended to promote evidence-based usage of antibiotics during outbreak of epidemic keratoconjunctivitis.

Methods: A descriptive study was designed. First 50 patients who visited the outpatient department of ophthalmology with signs and symptoms of EKC during the outbreak in the months of July-August, 2023 in a tertiary hospital in northern India were included in the study. Prior usage of topical antibiotics during this epidemic outbreak was the exclusion criteria. Conjunctival swabs were taken and subjected to Gram staining and Culture and sensitivity, for any bacterial infection.

Results: Only two slides of gram stain showed gram-positive cocci. These two samples were positive for Methicillin resistant Staphylococcs Aureus (MRSA). Rest of the 48 samples were negative for any bacterial growth. P value for no growth in bacterial cultures was <0.05, which is significant.

Conclusions: Our study suggests restrain from overusage of topical antibiotics in outbreaks of EKC until microbiological outcomes suggest otherwise. In view of presence of MRSA in neo-natal sample, and its known serious complications, we suggest prophylactic use of topical antibiotic and its modifications once reports of culture and sensitivity are available.

Keywords: Antibiotic resistance; bacteria; epidemic keratoconjunctivitis; fluoroquinolones; ocular infections.

Figure 1

Gram-positive Cocci seen in 2 samples

Figure 2

Culture showing growth of MRSA in 2 samples

Figure 3

Proportion of Bacterial growth in our study

Figure 4

Pictures showing few signs of EKC in our patients; a: Sub-conjunctival Hge; b: conjunctival chemosis; c: lid edema; d: redness of conjunctiva

Figure 5

Graph depicting pattern of reporting for 50 microbiological samples taken during EKC in our out-patient department

Figure 6

Distribution pattern of signs observed in 50 patients during EKC