H. Mino de Kaspar

In vitro antibiotic susceptibility of preoperative normal conjunctival bacteria.

PurposeTo determine the antibiotic susceptibility of preoperative conjunctival bacterial flora.MethodsAntibiotic susceptibility of conjunctival bacterial strains isolated from 142 patients undergoing intraocular surgery was determined using the Kirby–Bauer disc diffusion technique. χ2 statistical analysis was performed.ResultsAmong the 116 bacteria isolated, 95 (82%) were coagulase-negative staphylococci (CNS). Most (>75%) of them were susceptible to vancomycin, minocycline, aminoglycosides, gatifloxacin, levofloxacin, and moxifloxacin. Approximately one-half of CNS was resistant to erythromycin and azithromycin. Over 90% of streptococci were susceptible to levofloxacin, moxifloxacin, and gatifloxacin.ResultsFluoroquinolones, specifically gatifloxacin, levofloxacin, and moxifloxacin continue to provide broad-spectrum coverage against common conjunctival bacterial flora.

Prospective randomized study determining whether a 3-day application of ofloxacin results in the selection of fluoroquinolone-resistant coagulase-negative Staphylococcus.

PURPOSE To determine whether a 3-day application of ofloxacin results in the selection of fluoroquinolone-resistant conjunctival coagulase-negative Staphylococcus. DESIGN Prospective randomized trial. METHODS Patients scheduled for ocular surgery were randomized to a control (89 eyes) or study group (70 eyes). The study group received topical ofloxacin (0.3%) four times a day for 3 days. Conjunctival cultures were obtained at baseline (T0) and after 3 days of ofloxacin (T1). Cultures were also obtained at T0 and T1 for the control group, but these eyes did not receive an antibiotic. Bacteria isolated were identified and antibiotic susceptibility was determined. RESULTS At T0, 53 out of 89 patients (60%) in the control and 48 out of 70 patients (69%) in the study group harbored coagulase-negative Staphylococcus. Among these coagulase-negative Staphylococcus, 12 out of 53 in the control and 11 out of 48 in the study group were resistant to ofloxacin (p>0.9999). At T1, significantly fewer coagulase-negative Staphylococcus (p=0.0003) were isolated from the study group (18 coagulase-negative Staphylococcus), compared the control group (48 coagulase-negative Staphylococcus). Of these, 5 out of 17 coagulase-negative Staphylococcus in the study group and 9 out of 48 coagulase-negative Staphylococcus in the control group were resistant to ofloxacin (p=0.5649). There was no significant difference in the number of coagulase-negative Staphylococcus resistant to ciprofloxacin or norfloxacin in the study group compared to the control group at T1. CONCLUSIONS Ofloxacin given four times a day for 3 days does not select out for conjunctival fluoroquinolone-resistant coagulase-negative Staphylococcus.Purpose To determine whether a 3-day application of ofloxacin results in the selection of fluoroquinolone-resistant conjunctival coagulase-negative Staphylococcus. Design. Prospective randomized trial. Methods Patients scheduled for ocular surgery were randomized to a control (89 eyes) or study group (70 eyes). The study group received topical ofloxacin (0.3%) four times a day for 3 days. Conjunctival cultures were obtained at baseline (T0) and after 3 days of ofloxacin (T1). Cultures were also obtained at T0 and T1 for the control group, but these eyes did not receive an antibiotic. Bacteria isolated were identified and antibiotic susceptibility was determined. Results At T0, 53 out of 89 patients (60%) in the control and 48 out of 70 patients (69%) in the study group harbored coagulase-negative Staphylococcus. Among these coagulase-negative Staphylococcus, 12 out of 53 in the control and 11 out of 48 in the study group were resistant to ofloxacin (p>0.9999). At T1, significantly fewer coagulase-negative Staphylococcus (p=0.0003) were isolated from the study group (18 coagulase-negative Staphylococcus), compared the control group (48 coagulase-negative Staphylococcus). Of these, 5 out of 17 coagulase-negative Staphylococcus in the study group and 9 out of 48 coagulase-negative Staphylococcus in the control group were resistant to ofloxacin (p=0.5649). There was no significant difference in the number of coagulase-negative Staphylococcus resistant to ciprofloxacin or norfloxacin in the study group compared to the control group at T1. Conclusions Ofloxacin given four times a day for 3 days does not select out for conjunctival fluoroquinolone-resistant coagulase-negative Staphylococcus.

Eficacia de la aplicación tópica de 0,3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas

OBJECTIVE To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. PATIENTS AND METHODS Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. RESULTS Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%). CONCLUSION The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.

045 Incidence et pronostic des endophtalmies post-opératoires : étude sur cinq ans

Objectif Analyser l’incidence, l’etiologie et le pronostic des endophtalmies postoperatoires sur une periode de 5 ans. Materiels et Methodes Nous avons etudie retrospectivement tous les cas d’endophtalmie postoperatoire hospitalises au CHU entre janvier 2002 et novembre 2006. 47 patients ont ete divises en 3 groupes : A) endophtalmies aigues apres chirurgie dans l’etablissement (n = 12), B) endophtalmies aigues (n = 27) et C) endophtalmies chroniques (n = 8) apres chirurgie ailleurs. L’incidence, la chirurgie precedente, les resultats des prelevements microbiologiques, le traitement et la fonction visuelle ont ete analyses. Resultats L’incidence des endophtalmies postoperatoires dans notre etablissement a ete calculee 0,065 %. L’endophtalmie est survenue a la suite d’une chirurgie de la cataracte (A : n = 3, B : n = 23, C : n = 8), d’une chirurgie combinee cataracte et vitrectomie posterieure (A : n = 4, B : n = 1), d’une vitrectomie posterieure simple (A : n = 3), d’une keratoplastie (B : n = 1), d’une chirurgie filtrante (B : n = 1) et d’autres traitements (A/B : n = 3). Les endophtalmies survenues apres chirurgie dans l’etablissement ont ete decouvertes et traitees plus tot (4 ± 2 jours) que les endophtalmies envoyees (7 ± 7 jours). Les staphylocoques a coagulase negative (36 %) et les streptocoques (17 %) ont ete isoles le plus souvent dans les cultures des prelevements. Dans 15 % des cas aucun germe n’a pu etre isole. Le traitement par vitrectomie posterieure a ete choisi dans la plupart des cas (n = 40). Tous les patients ont beneficie d’un traitement antibiotique par voie vitreene, topique et intraveineuse. La fonction visuelle s’est amelioree significativement dans tous les groupes. Discussion L’incidence des endophtalmies est restee stable pendant 10 ans. Le plus souvent, une endophtalmie est survenue suite a une chirurgie de la cataracte, seulement dans notre etablissement apres chirurgie combinee. La chirurgie dans un centre specialise a un effet positif sur le delai de traitement. La fonction visuelle a beneficie d’un traitement par vitrectomie combine avec une antibiotherapie topique, intra-oculaire et intraveineuse. Conclusion L’endophtalmie reste une complication rare. Une prise en charge des patients ayant a subir une chirurgie intraoculaire par un centre specialise et dans le cas d’endophtalmie une vitrectomie posterieure combinee avec une antibiotherapie par voie vitreenne et intraveineuse sont recommandees.