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Review Ocular Infection Antibiotic Resistance Trends Among Ocular Pathogens in the US—Cumulative Results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study Penny A Asbell 1 and Christine M Sanfilippo 2 1.Cornea Service and Refractive Surgery Center, Icahn School of Medicine at Mount Sinai, New York, New York, US; 2. Pharmaceutical Medical Affairs, Bausch + Lomb, Rochester, New York, US A ntibiotic resistance among ocular pathogens is a public health concern. The multicenter, prospective Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing surveillance study designed to report on antibiotic resistance rates and trends among Staphylococcus aureus, coagulase-negative staphylococci (CoNS; includes Staphylococcus epidermidis), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Results for more than 4,000 isolates collected from 2009 –2015, representing 7 years of ARMOR, were recently presented. More than a third of S. aureus and almost half of all CoNS isolates were found to be resistant to methicillin. Staphylococcal isolates also showed high levels of multidrug resistance (resistance to ≥3 antibacterial drug classes) with 76.4% and 73.7% of methicillin-resistant S. aureus (MRSA) and methicillin-resistant CoNS (MRCoNS) isolates, respectively, demonstrating multidrug resistance. Resistance among S. pneumoniae was notable for azithromycin (36.8%) and for penicillin (34.0%), whereas P. aeruginosa and H. influenzae were generally susceptible to the antibiotic classes tested. Longitudinal analyses demonstrated a small decrease in methicillin resistance among S. aureus over the 7-year study period, which may be a result of improved antibiotic stewardship. Continued surveillance of antibiotic resistance among ocular pathogens is warranted. Keywords ARMOR, surveillance study, antibiotic resistance, ocular infections, Staphylococcus aureus Disclosure: Penny A Asbell is a consultant to Perrigo and Kurobe, and participates in advisory boards for Valeant/Bausch + Lomb. She is a speaker on continuing medical education topics at professional meetings for Vindico. Christine M Sanfilippo is an employee of Bausch + Lomb. Acknowledgment: Medical writing assistance was provided by Katrina Mountfort and Michelle Dalton for Touch Medical Media, supported by Bausch + Lomb, a division of Valeant Pharmaceuticals International Inc. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: February 16, 2017 Accepted: March 9, 2017 Citation: US Ophthalmic Review, 2017;10(1):35–8 Corresponding Author: Penny A Asbell, MD, MBA, Cornea Service and Refractive Surgery Center, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Annenberg Bldg 22-12, New York, NY 10029, US. E: penny.asbell@mssm.edu Support: The publication of this article was supported by Bausch + Lomb, a division of Valeant Pharmaceuticals International Inc., who were given the opportunity to review the article for scientific accuracy before submission. Any resulting changes were made at the author’s discretion. TOU CH MED ICA L MEDIA Antibiotic-resistant bacteria cause infections worldwide, with potentially serious health consequences, 1 although the majority of such infections involve resistance to systemically administered antibiotics used in the treatment of systemic infections. The first case of methicillin resistance in Staphylococcus aureus (MRSA) was reported in 1961, and was an uncommon finding until the 1990s when community-acquired MRSA became so prevalent in the general population that health authorities considered it endemic. 2 Although the incidence of healthcare-associated MRSA infections is declining due to preventive hygiene measures in the hospital setting, rates of community-acquired MRSA infections have increased in the general population over the last 10 years. Other pathogens that are resistant to antibiotics include vancomycin-resistant enterococci and multidrug-resistant Streptococcus pneumoniae, Mycobacterium tuberculosis, and Neisseria gonorrhoeae. In the US, the Centers for Disease Control and Prevention (CDC) and leading scientists have developed strategies to help reduce antibiotic resistance that include improving diagnosis, tracking and prescribing practices, optimizing therapeutic regimens, adopting antibiotic stewardship programs, and preventing infection transmission. 1 Ophthalmic bacterial infections are often treated before the causative pathogen is identified, and as such, antibiotic resistance in ocular infections is of particular concern. Whether an infection is on the ocular surface or intraocular, permanent loss of vision may result if appropriate treatment is not initiated promptly, and antibiotic-resistant pathogens can complicate treatment selection. S. aureus, coagulase-negative staphylococcal (CoNS), S. pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae are common causes of ocular bacterial 35