[Preoperative microbiologic diagnosis before elective intraocular interventions and prevention of infection with tobramycin eyedrops. Results of a multicenter study].
Preoperative conjunctival smears of 313 asymptomatic patients before cataract surgery were evaluated in an open multi-center study in 10 German surgical eye care centers from May to August 1987. 230 evaluable isolates of 198 patients (= 61.1%) on agar plates with a 48 h incubation period revealed 190 gram-positive (most frequent isolates: 62.2% coagulase negative Staph., 13.5% coagulase positive Staph.) and 40 gram negative agents (most frequent isolates: 3.0% Proteus sp., 2.2% Pseudomonas sp.). Coinfections with gram-positive organisms were seen in 22%, and with gram-negative organisms in 9% of cases. Newly acquired potentially pathogenic bacteria were demonstrated after one day (5-8 drops 3 mg/ml Tobramycin (Tobramaxin; 1 x ointment in the evening 3 mg/100 mg Tobramycin (Tobramaxin] of topical prophylaxis in 6 of 115 (= 5.2%) previously negative and 22 of 198 (= 11%) previously positive conjunctival cultures. Coagulase negative Tobramycin sensitive Staph. persisted in 41 of 110 patients (= 37.3%) and coagulase positive Tobramycin-sensitive Staph. in 4 of 30 (= 13.3%). Each of the gram-negative bacteria could be eliminated after one day of topical prophylaxis with Tobramycin eye drops and ointment in this study. The statistically determined elimination rate estimated for a one-day topical prophylaxis with Tobramycin in asymptomatic culture-positive persons was 77.5-89.8% (95% confidence interval/Pearson and Clopper). The statistically determined probability for potentially pathogenic bacteria in a previously culture-negative patient after topical preoperative Tobramycin prophylaxis was 3.1-13.2% (95% confidence interval/Pearson and Clopper). Thus, additional supportive antibiotic measures are to be taken pre- and perioperatively by the intraocular surgeon to minimize the risk of postoperative endophthalmitis.
Bialasiewicz
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Augenklinik mit Poliklinik, Friedrich Alexander Universität Erlangen-Nürnberg.
Welt
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R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000382:microbiology*; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011292:Premedication; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control; D015163:Superinfection / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D014031:Tobramycin / Q000008:administration & dosage*
D009883:Ophthalmic Solutions; D014031:Tobramycin
Präoperative mikrobiologische Diagnostik vor elektiven intraokularen Eingriffen und Infektionsprophylaxe mit Tobramycin-Augentropfen. Ergebnisse einer multizentrischen Studie.