For many of us premium surgeons, golf season has finally arrived, especially in regions such as the Midwest for me. On Memorial Day weekend, I embarked on my first rounds of the year after taking a fairly long sabbatical from lumbar fusion surgery 4 years ago and a broken fibula last September. The most frustrating part of that weekend was how horrible I played when at one time I was a 6 handicap golfer, but I was thankful to be playing again without injury nevertheless.
As premium surgeons, we rarely experience that hopeless feeling of never wanting to touch a golf club again when perfect uncomplicated cataract surgery results in an unexpected intraocular infection in the immediate postoperative period for no apparent reason or known risk factors. The typical endophthalmitis pathogens of increasing prevalence are coagulase-negative staphylococci (CoNS) and methicillin-resistant Staphylococcus aureus (MRSA). Endophthalmitis rates vary from 0.028% to 0.3%, with the accepted U.S. rate approaching one in 1,000 to one in 1,500. Typical high-risk patients for developing MRSA infections after cataract surgery are prison inmates, military recruits, HIV-positive or other immunosuppressed patients (for example, diabetic patients), homeless persons, intravenous drug abusers, tattoo recipients, health care professionals (especially hospital-based), those with a known MRSA history, and those residing in nursing homes.
Unfortunately, bacteria are getting smarter with a wide array of mechanisms to develop resistance to antibiotics no matter the method of delivery to the eye. Alteration and protection of antibiotic targets via genetic mutation and/or post-translational modification; direct modification or inactivation of antibiotics via hydrolysis and/or addition of a chemical group; prevention of access to drug targets via reduction in membrane permeability and/or active cell efflux; spontaneous mutation due to environmental stresses; horizontal gene transfer via transformation, transduction and/or conjugation; and the inappropriate use of systemic antibiotics in internal medicine, veterinary medicine and agriculture all contribute to the increasing resistance of bacteria, especially MRSA, in intraocular surgery.
- Click here to read the full publication exclusive, The Premium Channel, published in Ocular Surgery News U.S. Edition, July 10, 2017.