In-Vitro efficacy of antimicrobial agents used in the treatment of bacterial eye infections in Ibadan, Nigeria

Failure to cure eye infections, and reduced potency in topical antimicrobials had been observed in South Western Nigeria, this study sought to evaluate in vitro, the efficacy of antimicrobial agents in the treatment of ocular infections. A total of 46 ocular bacterial isolates were recovered from the diagnostic laboratory of the University College Hospital, Ibadan, from conjunctival swabs of patients having underlying eye diseases (Cataracts, glaucoma and esotrapia), and from patients presenting with other symptoms of eye infections. The pathogens incriminated were Staphylococcus aureus (73.5%), Coagulase negative Staphylococci (13.3%), Klebsiella species (10.3%), and Pseudomonas aeruginosa (2.0%). Disc diffusion tests (Bauer-Kirby method) were carried out using ciprofloxacin, gentamicin, chloramphenicol, erythromycin, augmentin, cefuroxime and levofloxacin. Broth dilution techniques were thereafter performed using gentamicin, chloramphenicol and ciprofloxacin. The microlide- erythromycin was 63.0% efficacious, augmentin and cefuroxime showed 71.1% and 76% efficacy. Minimum inhibitory concentrations (MIC) of commonly used topical antibiotics however showed different levels of resistance. Resistance to the aminoglycosides was marked, yielding 53.4% with MIC50= 8, MIC90 > 256, Resistance to chloramphenicol was even more marked 69.6% with MIC50= 16, MIC90= 64, the fluoroquinolones showed high efficacy- levofloxacin and ciprofloxacin showed 93.4% and 82.6% susceptibility respectively with MIC50 < 0.5, though slightly demonstrable resistance was observed (MIC90= 8). The study thus recommends the discontinuation of empirical therapy by physicians in order to stem the tide of resistance; it justifies the inclusion of the fluoroquinolones in susceptibility testing of ocular bacterial isolates, and its first line of choice if cure is warranted.doi: 10.4314/ajcem.v12i3.

Implementing an innovative consent form: the PREDICT experience

<p>Abstract</p> <p>Background</p> <p>In the setting of coronary angiography, generic consent forms permit highly variable communication between patients and physicians. Even with the existence of multiple risk models, clinicians have been unable to readily access them and thus provide patients with vague estimations regarding risks of the procedure.</p> <p>Methods</p> <p>We created a web-based vehicle, PREDICT, for embedding patient-specific estimates of risk from validated multivariable models into individualized consent documents at the point-of-care. Beginning August 2006, outpatients undergoing coronary angiography at the Mid America Heart Institute received individualized consent documents generated by PREDICT. In February 2007 this approach was expanded to all patients undergoing coronary angiography within the four Kansas City hospitals of the Saint Luke's Health System. Qualitative research methods were used to identify the implementation challenges and successes with incorporating PREDICT-enhanced consent documents into routine clinical care from multiple perspectives: administration, information systems, nurses, physicians, and patients.</p> <p>Results</p> <p>Most clinicians found usefulness in the tool (providing clarity and educational value for patients) and satisfaction with the altered processes of care, although a few cardiologists cited delayed patient flow and excessive patient questions. The responses from administration and patients were uniformly positive. The key barrier was related to informatics.</p> <p>Conclusion</p> <p>This preliminary experience suggests that successful change in clinical processes and organizational culture can be accomplished through multidisciplinary collaboration. A randomized trial of PREDICT consent, leveraging the accumulated knowledge from this first experience, is needed to further evaluate its impact on medical decision-making, patient compliance, and clinical outcomes.</p