Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility

Abstract

BackgroundThe purpose of the present study was to evaluate the microbiological spectrum and antimicrobial susceptibility in patients with scleral buckle infection. Medical records of all the patients diagnosed as buckle infection at L. V. Prasad Eye Institute between July 1992 and June 2012 were reviewed in this non-comparative, consecutive, retrospective case series.FindingsA total of 132 eyes of 132 patients underwent buckle explantation for buckle infection during the study period. The incidence of buckle infection at our institute during the study period was 0.2% (31 out of 15,022). A total of 124 isolates were identified from 102 positive cultures. The most common etiological agent isolated was Staphylococcus epidermidis (27/124, 21.77%) followed by Mycobacterium sp. (20/124, 16.13%) and Corynebacterium sp. (13/124, 10.48%). The most common gram negative bacilli identified was Pseudomonas aeruginosa (9/124, 7.26%). The median interval between scleral buckling surgery and onset of symptoms of local infection was 30 days. All eyes underwent buckle explantation and median time interval between primary SB surgery and explantation was 13 months. Recurrent retinal detachment was observed in two cases at 7 and 48 months, respectively, after buckle explantation. Gram positive, gram negative, and acid-fast organisms isolated from 2003 to 2012 were most commonly susceptible to vancomycin (100%), ciprofloxacin (100%), and amikacin (89%). Susceptibility to ciprofloxacin during the same time period was observed in 75% (15/20), 100% (13/13), and 87% (7/8) of gram positive, gram negative, and acid-fast isolates, respectively.ConclusionScleral buckle infection is relatively rare and has a delayed clinical presentation. It is most commonly caused by gram positive cocci. Based on the current antimicrobial susceptibility, ciprofloxacin can be used as empirical therapy in the management of scleral buckle infections.

Organo-Selenium Coatings Inhibit Gram-Negative and Gram-Positive Bacterial Attachment to Ophthalmic Scleral Buckle Material

“…(13/124, 10.48%), while the most common gram-negative bacilli identified was P. aeruginosa (9/124, 7.26%). 2 Postoperative infection with rejection of the scleral implants occurred in 4% (37) of 878 operations (Ulrich and Burton 20 ), while in a more recent study the rate was 0.2% (31 of 15,022). 2 , 20 The management of these infections includes the use of systemic and local antibiotics, although removal of the scleral buckle usually is necessary to eliminate infection.…”

“… 16 However, infections after insertion of a scleral buckle are a significant complication and the most frequently isolated organisms have been S. epidermidis and S. aureus. 2 – 4 , 17 Infection rates have varied from 0.1% to 0.2% to an average of 3.3%. 2 , 18 , 19 Cultures of 638 routine preoperative conjunctival specimens before retinal detachment surgery demonstrated bacterial contamination with S. epidermidis in 37%, S aureus in 3%, Proteus in 1%, Klebsiella in 1%, and Pseudomonas in 0.2%.…”

“… 2 – 4 , 17 Infection rates have varied from 0.1% to 0.2% to an average of 3.3%. 2 , 18 , 19 Cultures of 638 routine preoperative conjunctival specimens before retinal detachment surgery demonstrated bacterial contamination with S. epidermidis in 37%, S aureus in 3%, Proteus in 1%, Klebsiella in 1%, and Pseudomonas in 0.2%. A more recent study found the most common etiological agent isolated was S. epidermidis (27/124, 21.77%) followed by Mycobacterium sp.…”

“…Biofilm formation can be a problem for solid and sponge-type scleral buckles. 1 – 5 This can lead to complications that can require removal of the buckle, which may result in vision loss due to related ocular morbidity, primarily infection, or recurrent retinal detachment. Thus, it would be desirable to have a coating on these buckles that would resist bacterial biofilm formation.…”

Infectious conjunctivitis caused byPseudomonasaeruginosain infected and extrused scleral buckles

“…In fact biofilm blocked antibiotics penetration and, once the buckles have been removed, antibiotic therapy allowed both patients to have a complete recovery. We have to remember that this is an extreme solution and often it is possible to manage explant infections without undergoing surgery, avoiding risks as retinal detachment and infection spreading 15. In these cases not only we were forced to remove the silicone explant due to the difficulty of antibiotic penetration but we did have an anteriorisation of the scleral buckling that resulted inefficient.…”