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[Incidence of postoperative bacterial infections after planned intraocular interventions]
V Rummelt1, H J Boltze, A A Bialasiewicz
1Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg.
Abstract:
Between August 1982 and August 1984 3059 intraocular operations were performed with topical prophylactic antibiotics. Results of conjunctival cultures did not influence the surgical schedule. 8179 intraocular operations were performed between September 1984 and August 1988. An intraocular operation was postponed until conjunctival cultures were negative using topical antibiotics administered at hourly intervals. The rate of postoperative intraocular infections decreased significantly (p less than 0.0001) from 21 (0.69%) of 3059 during the first to 9 (0.11%) of 8179 intraocular operations during the second observation period. In the first period 11 vitrectomies and 2 enucleations due to bacterial endophthalmitis had to be performed. In the second period 2 vitrectomies and no enucleations were necessary (p less than 0.0001). Our results indicate, that decontamination of the conjunctiva may be an import factor for the prevention of postoperative endophthalmitis following elective intraocular surgery.
Insights
Preventing postoperative endophthalmitis in intraocular surgery is possible through conjunctival decontamination. This study shows a significant decrease in infections and related complications by ensuring negative conjunctival cultures before elective procedures.
Area of Science:
- Ophthalmology
- Infectious Disease Prevention
- Surgical Outcomes
Background:
- Postoperative endophthalmitis is a serious complication following intraocular surgery.
- Previous practices involved topical prophylactic antibiotics without mandatory negative conjunctival cultures.
- The incidence of infection and subsequent severe outcomes like vitrectomies and enucleations were noted.
Purpose of the Study:
- To evaluate the impact of conjunctival decontamination on the rate of postoperative endophthalmitis.
- To compare infection rates and severe complications before and after implementing a policy of negative conjunctival cultures.
Main Methods:
- A retrospective analysis of intraocular operations performed between August 1982 and August 1984 (n=3059) with standard topical antibiotics.
- A subsequent period (September 1984 to August 1988, n=8179) where surgeries were postponed until conjunctival cultures were negative, with hourly topical antibiotic use.
- Comparison of postoperative intraocular infection rates and the need for vitrectomies or enucleations between the two periods.
Main Results:
- A significant decrease in postoperative intraocular infections from 0.69% (21/3059) to 0.11% (9/8179) (p < 0.0001).
- A significant reduction in the need for vitrectomies (from 11 to 2) and enucleations (from 2 to 0) (p < 0.0001).
- The change in surgical scheduling based on conjunctival culture results was associated with improved outcomes.
Conclusions:
- Conjunctival decontamination, achieved by ensuring negative cultures before surgery, is a crucial factor in preventing postoperative endophthalmitis.
- Implementing a policy of postponing elective intraocular surgery until conjunctival cultures are negative significantly reduces infection rates and severe complications.
- This strategy represents an effective method for enhancing patient safety in intraocular surgical procedures.