The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis

Abstract

Purpose To assess the prevalence of the antibiotics resistant conjunctival bacteria in order to adapt our cataract surgery prophylaxis to the new prophylaxis techniques.

A review of preoperative manoeuvres for prophylaxis of endophthalmitis in intraocular surgery

“…was also sensitive to fluoroquinolones. Fernández-Rubio et al [39] assessed the prevalence of antibiotic resistance among conjunctival bacteria in patients undergoing cataract surgery. The conclusion was that none of antibiotics tested (including cefuroxime and levofloxacin) were active against all of the organis ms isolated from the conjunctiva.…”

Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

“…16,35 Patients were instructed for not washing their eyes and not using any kind of ocular drops in the morning before the specimens were collected; and also not using antibiotics during the previous 48 h. The identification and antibioticsusceptibility test of non-exigent growing bacteria was performed as follows: panel PC23 was used for Enterococci, all Staphylococci with positive mannitol test and those Staphylococci mannitol negative, when more than five colony-forming units (CFU) per microlitre, were isolated; panels PC38 and PUC37 were used for Gramnegative rods All these panels (from Dade Behring, Siemens Healthcare Diagnostics, Barcelona, Spain) were automatically read and recorded in the AutoScan4 microbiological system (Siemens Healthcare Diagnostics). For more exigent growing bacteria, the identification of Haemophilus, Neisseria, and Moraxella was carried out with the HNID Dade Behring panel.…”

“…For similar reasons, because of the current efficacy of the prophylaxes, 4,5,10 the ascertaining of the value of the systemic co-morbidities as potential indicator of the PE risk is restricted to those PE cases caused by pathogenic bacteria highly resistant to the prophylaxes. For instance, after using topical chlorhexidine solution and intracameral cefuroxime, the PE incidence caused by Enterococci was relatively high (23% of their PE cases) in Sweden, 4 probably owing to the antimicrobial resistance of these bacteria (according to our antibiotic resistance pattern 35 ). In the present study, the conjunctival prevalence of Enterococci was 2.1%, and this bacterial colonisation was associated with diabetes and advanced age.…”

The conjunctival bacterial pattern of diabetics undergoing cataract surgery

“…But, in another study 18 with a similar prophylaxis and a less restrictive inclusion criteria of the patients, a wider bacterial spectrum was isolated from their PE cases. 19 Other studies of cataract operations carried out in outpatient surgical units 20,21 generated a PE incidence as low as in the mentioned studies 17,18 without using intracameral antibiotics; but possibly the health status of the patients operated on in outpatient units is better than in a tertiary hospital.…”

“…Among these bacteria, Enterococci present a high antibiotic resistance pattern, 19,45 and this resistance is on the increase in S. aureus. 32,46 An advanced age and an abnormally high blood creatinine level are also associated with an increased conjunctival bacterial colonisation in diabetics and non-diabetics; these two simple figures could be reliable indicators of the contamination risk.…”