We appreciate the interest of Galvis and associates in our study. We additionally applaud them for doing a surveillance of the local bacterial pathogens encountered in their geographic area. The authors point out the results of the ESCRS endophthalmitis study, which supports the usage of intracameral cefuroxime for peri–cataract surgery prophylaxis instead of topical antibiotics application. Additionally, we would like to point out a more recent report from Northern California that additionally supports the use of intracameral antibiotics. However, our original study is intended to only evaluate the ocular flora and their antibiotic susceptibility patterns in the Saint Louis community and not to deeply discuss the pros and cons of various methods of endophthalmitis prophylaxis. A discussion of endophthalmitis prophylaxis is likewise beyond the scope of the current correspondence.
The authors correctly point out that the results of our study more closely match those from other investigators in the United States and differ more significantly with results from other parts of the world, including their institution. The authors emphasize that in other parts of the world, staphylococcal resistance to aminoglycosides (specifically tobramycin) is markedly higher than what we encounter in Saint Louis. Whereas the resistance rate of gram-positive organisms to aminoglycosides (gentamicin) is 5% in Saint Louis, it is 85% (to tobramycin) in Colombia. As a result, the authors voice their concern regarding our recommendation to cataract surgeons to consider aminoglycosides for perioperative prophylaxis.
Throughout our original publication, we emphasize several times that readers should extrapolate our findings with caution as antibiotic resistance rates vary over geographic areas as well as over time. As a result, surgeons should investigate and be aware of their local antibiotic susceptibility patterns. Again, we applaud the authors for having done just that at their institutions. Implicit in the recommendation and concluding statements from our publication is that they are intended for ophthalmologists in the Saint Louis area as well as other communities that share similar antibiotic susceptibility patterns—specifically, those areas that have high and growing fluoroquinolone resistance rates and relatively low levels of aminoglycoside resistance. Nonetheless, we appreciate the authors for pointing out the need for clarification. Additionally, we would like to clarify and stress an implied point made by the authors: Although aminoglycosides may be a poor choice at their institutions and other parts of the world where resistance rates are high, surgeons in parts of the world where aminoglycosides retain a favorable resistance pattern should not be dissuaded from utilizing this class of antibiotics.