A routine and generally safe cataract surgery, a beacon of hope for millions seeking restored vision, is confronting a grave new challenge in Hyderabad and beyond. Medical experts are raising alarms over a surge in severe post-operative eye infections driven by bacteria that have become resistant to standard antibiotics, placing patients in danger of irreversible vision damage.
The Silent Pandemic Hits the Operating Theatre
This alarming trend emerges against the global backdrop of growing antimicrobial resistance (AMR), a crisis the World Health Organisation terms a 'silent pandemic' with the potential to claim 10 million lives annually by 2050. A recent study conducted by doctors at the city's prestigious LV Prasad Eye Institute (LVPEI) has pinpointed a worrying increase in drug-resistant bacteria linked to endophthalmitis. This is a serious infection that can develop within days of cataract surgery and advance swiftly, causing permanent harm if not treated promptly and effectively.
The research, which analysed 410 cases of post-cataract endophthalmitis, found that 32 were caused by multidrug-resistant bacteria, with most being Gram-negative types. A particularly dangerous bacterium, Pseudomonas aeruginosa, was responsible for more than half of these resistant infections. This pathogen is notorious for rapidly developing resistance to multiple drugs and can cause irreversible damage to the eye within mere hours.
Last-Resort Drugs and Disturbing Resistance Patterns
Typically, endophthalmitis is treated by injecting antibiotics directly into the eye. The standard protocol uses vancomycin for Gram-positive bacteria and ceftazidime for Gram-negative ones. However, the study uncovered a sharp rise in resistance to ceftazidime, forcing ophthalmologists to turn to colistin, a powerful antibiotic reserved as a last line of defence.
Laboratory findings revealed a disturbing landscape of resistance: nearly 93% of bacteria were resistant to fluoroquinolones, about 39% to ceftazidime, and alarmingly, five samples showed resistance even to colistin. The treatment outcomes were often poor. In the studied cases, three patients lost their eyes, several showed no visual improvement, and only a few managed to regain good vision. Notably, no patient treated with colistin lost an eye, indicating its current efficacy, but the emerging resistance signals a serious future threat.
An Urgent Call for Prudent Use and New Alternatives
Lead author Dr Taraprasad Das warned that the findings reflect a dangerous trajectory. "Even last-line antibiotics are becoming less effective. We must use these drugs wisely and urgently search for better alternatives," he stated. The medical team emphasised that potent antibiotics like colistin and vancomycin should be used sparingly and strictly for severe, sight-threatening or life-threatening cases.
The study underscores an urgent need for continuous monitoring of antibiotic resistance patterns and the accelerated development of new treatment options. For patients undergoing one of the most common surgeries worldwide, this evolving threat highlights the critical importance of infection control protocols and the global fight against antimicrobial resistance.
