title: Multinational Comparison of Prophylactic Antibiotic Use for Eyelid Surgery.
abstract: OBJECTIVE
  Antibiotic stewardship is important in controlling resistance, adverse reactions, and cost. The literature regarding antibiotic use for eyelid surgery is lacking.
  
  
  OBJECTIVE
  To determine standard care and assess factors influencing antibiotic prescribing practices for eyelid surgery.
  
  
  METHODS
  A survey study was conducted from February 2, 2014, to March 24, 2014. The survey was distributed to 2397 oculoplastic surgeons in private and academic oculoplastic surgery practices in 43 countries. All surgeons were members of ophthalmic plastic and reconstructive surgery societies. Data were analyzed by geographic location. Linear regression was performed to quantify contributions to rates of prescribing postoperative antibiotics for routine eyelid surgical procedures.
  
  
  METHODS
  Rates of prescribing prophylactic intravenous, oral, and topical antibiotics as well as factors that influence surgeons' prescribing practices.
  
  
  RESULTS
  A total of 782 responses were received from 2397 surgeons (average response rate, 36.7%; 2.5% margin of error) from 43 countries. Topical antibiotic use was common in all regions (85.2%). Perioperative intravenous antibiotic use was uncommon in all regions (13.5%). Geographic location was the greatest predictor of antibiotic prescribing practices (range, 2.9% in the United Kingdom to 86.7% in India; mean, 24%). Within Europe, Italy had the highest rate of antibiotic prescriptions for eyelid surgery (41.7%) and the United Kingdom had the lowest rate (2.9%.) In South America, Venezuela had the highest rate of antibiotic prescriptions for eyelid surgery (83.3%) and Chile had the lowest rate (0%). The practice locations that were associated with routinely prescribing postoperative oral antibiotics were India (odds ratio [OR], 15.83; 95% CI, 4.85-51.68; P < .001), Venezuela (OR, 13.47; 95% CI, 1.43-127.19; P = .02), and Southeast Asia (OR, 2.80; 95% CI, 1.15-6.84; P = .02). Conversely, practice location in the United Kingdom (OR, 0.048; 95% CI, 0.0063-0.37; P = .004), Australia and New Zealand (OR, 0.15; 95% CI, 0.033-0.67; P = .01), and the United States and Canada (OR, 0.41; 95% CI, 0.23-0.72; P = .002) were associated with decreased rates of postoperative oral antibiotic use. Surgeons' concern for allergic reactions was associated with decreased rates of prescribing antibiotics (OR, 0.34; 95% CI, 0.23-0.49; P < .001), while surgeons' concern for infection was associated with increased rates of prescribing antibiotics (OR 1.80; 95% CI, 1.45-2.23; P < .001).
  
  
  CONCLUSIONS
  These results from members of ophthalmic plastic and reconstructive surgery societies confirm that antibiotic prescribing practices for routine eyelid surgical procedures vary widely throughout the world. No standard of care has been established that would require the routine use of postoperative prophylactic antibiotics following eyelid surgery.
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Aaron
authors.initials: A
authors.lastname: Fay
authors.affiliation: Duke University Eye Center, Durham, North Carolina.
authors.forename: Nambi
authors.initials: N
authors.lastname: Nallasamy
authors.affiliation: Oculoplastica Bernardini, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bernardini
authors.affiliation: Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Wladis
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston6Infectious Disease Service, Massachusetts Eye and Ear Infirmary, Boston7Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
authors.affiliation: Consultores Oftalmologicos, Buenos Aires, Argentina.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Devoto
authors.affiliation: Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York.
authors.forename: Dale
authors.initials: D
authors.lastname: Meyer
authors.affiliation: Department of Ophthalmology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Morris
authors.initials: M
authors.lastname: Hartstein
authors.affiliation: Ophthalmic and Facial Plastic Surgery and Ocular Oncology Centre for Sight, Hyderabad, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Honavar
authors.affiliation: Ophthalmic Plastic Surgery Division, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Midori H
authors.initials: MH
authors.lastname: Osaki
authors.affiliation: Ophthalmic Plastic Surgery Division, Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Tammy H
authors.initials: TH
authors.lastname: Osaki
authors.affiliation: Eye Institute, St Luke's Medical Center, Quezon City, Philippines.
authors.forename: Yvette M
authors.initials: YM
authors.lastname: Santiago
authors.affiliation: Oculoplastic and Orbital Surgery Unit, Ophthalmology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Sales-Sanz
authors.affiliation: Department of Ophthalmology, Ivrea Hospital, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vadala
authors.affiliation: Ophthalmic Plastic and Reconstructive Surgery, Moorfields Eye Hospital, London, England.
authors.forename: David
authors.initials: D
authors.lastname: Verity
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000706:statistics & numerical data; D001118:Argentina; D001291:Attitude of Health Personnel; D002170:Canada; D016001:Confidence Intervals; D005141:Eyelid Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007194:India; D038622:Internationality; D007558:Italy; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016017:Odds Ratio; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009885:Ophthalmology / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D012044:Regression Analysis; D013530:Surgical Wound Infection / Q000517:prevention & control; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States