This article systematically reviews the mechanisms and evolution of antibiotic resistance in ocular pathogens, analyzing resistance patterns, potential biochemical and genetic mechanisms, and clinical impacts. It also explores antimicrobial stewardship, novel drug delivery platforms, and alternative treatment strategies such as phage therapy and antimicrobial peptides, providing directions for future treatments of drug-resistant infections.
Literature Overview
This article, 'Mechanisms and Evolution of Antimicrobial Resistance in Ophthalmology: Surveillance, Clinical Implications, and Future Therapies', published in the journal Antibiotics, reviews and summarizes the current status of antimicrobial resistance (AMR) in ocular infections, including resistance mechanisms, major causative pathogens, and their impacts on treatment failure and vision loss. The study further explores the role of rapid diagnostics, molecular testing, and genomic surveillance in AMR management, and proposes innovative treatment strategies such as antimicrobial stewardship, phage therapy, and the use of antimicrobial peptides.
Background Knowledge
Antimicrobial resistance poses a significant challenge to global health. In ocular infections, resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), fluoroquinolone-resistant Pseudomonas aeruginosa, and resistant Streptococcus pneumoniae notably compromise clinical outcomes. The article highlights that AMR in ophthalmology develops primarily through genetic mutations, horizontal gene transfer, and biochemical mechanisms (e.g., enzyme degradation, target modification, efflux pumps), while biofilm formation further complicates treatment. Global surveillance systems such as GLASS, ARMOR, and Ocular TRUST provide critical data to guide empirical therapies and optimize antimicrobial use. Advances in diagnostic technologies, including PCR, rapid molecular testing, and AI-driven resistance prediction, offer new avenues for precision treatment. The article also emphasizes the necessity of interdisciplinary collaboration and global coordination to combat AMR, safeguarding both vision and public health.
Research Methods and Experiments
This study employed a narrative synthesis approach, integrating relevant literature from multiple databases—including PubMed, Scopus, Web of Science, MEDLINE, Embase, and Google Scholar—spanning from database inception to 2025. The focus was on resistance patterns, mechanisms, and clinical impacts of common ocular pathogens. Additionally, the study discussed key drivers of AMR, such as local antibiotic overuse, prophylactic administration, suboptimal dosing, and systemic resistance leading to cross-resistance. The role of rapid diagnostics, molecular testing, and genomic surveillance in AMR management was also reviewed.
Key Conclusions and Perspectives
Research Significance and Prospects
This review provides a comprehensive analysis of AMR in ophthalmology for clinicians, researchers, and policymakers, emphasizing the need for early detection, precise antimicrobial use, and global cooperation. Future research should focus on molecular characterization of resistance mechanisms, development of personalized treatment regimens, and the application of artificial intelligence and genomics in resistance prediction.
Conclusion
The rapid emergence of antimicrobial resistance in ophthalmology has become a major challenge in clinical management. This article systematically summarizes resistance mechanisms, epidemiological characteristics, and their impact on treatment and public health, while proposing innovative solutions including antimicrobial stewardship, phage therapy, and genomic surveillance. Future efforts should focus on strengthening laboratory capacity, promoting precision medicine, and enhancing international collaboration to combat resistant infections and protect global vision health.
