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  • Chris Thiagarajah MD

New Superbacteria and How it Fits into Orbital Cellulitis and Periocular Infections



One of the more common diseases of the orbit in Colorado that I see is orbital cellulitis. In children it is the most common cause of a bulging eye or proptosis. Recently an American woman with no travel experience was identified with an E Coli super bacteria with resistance to coliston. Coliston is the last antibiotic line of defense we have against bacteria. This bacteria is potentially resistant to all antibiotics. Orbital infections or orbital cellulitis are a common occurrence in the population, especially in patients who have chronic sinus infections. Sometimes the bacteria can create pockets of pus or abscesses in the orbit. These can cause vision loss and blindness when untreated. As an oculoplastic surgeon, it is a common disease entity that is treated in my office in Denver.

Most orbital cellulitis of the orbit is responsive to antibiotics. Sometimes when an abscess forms it has to be drained and subsequently antibiotics need to be administered. A bacteria that is resistant to all bacteria would have a catastrophic effect on the orbit and eye. Potentially it could spread to the brain via the optic canal and cavernous sinus.

Multidrug or pan-resistant bacteria in the orbit are a result of overprescription of antibiotics. In countries like India where antibiotics are found over the counter have very high rates of bacterial resistance. In a world of yelp reviews of doctors where patients expect the doctor to “do something”, antibiotics are often given in response to patient demands. The most common example in the ophthalmology world where pink eye or conjunctivitis is often viral but patients are given antibiotic drops often. This has resulted in bacteria multidrug resistance.

Some seeds mankind plants take a long time to evolve and grow. The seed of antibiotic overprescription has now started blossoming. In the orbit, eyelid or tear duct bacteria can wreck havoc and I hope we can develop a new antibiotic line in time along with controling our over prescription of antibiotics.


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