Anterior chamber bacterial contamination in cataract surgery
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Published on: May 31, 2024
Jorge E Valdez-García1, Alejandro Climent, Eduardo Chávez-Mondragón
1Ophthalmology Research Chair, Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Av, Morones Prieto No, 3000 Pte, Col, Los Doctores, C,P, 64710 Monterrey, Nuevo León, México. jorge.valdez@itesm.mx.
Background:
The incidence of postoperative endophthalmitis has reduced during last several years to <0.01%; however, its associated complications continue to be devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified. The objective of this study was to evaluate the surgical technique, antibiotics, and asepsis that are used to reduce the risk of infection during cataract surgery.
Methods:
This was a transversal prospective study, in which 64 cataract surgeries were evaluated from 32 patients, with 1 month recovery time; and cultures from preoperative and postoperative aspirates were analyzed. Two groups were established based on whether preoperative antibiotics were given or not. The analysis employed descriptive statistics.
Results:
Of the 32 patients whose aspirates were obtained, three (9.37%) and 10 (31.25%) yielded positive cultures preoperative and postoperatively respectively. Staphylococcus species was the most common contaminating bacteria. The isolation of Staphylococcus species may indicate its potential as exogenous contaminant at time of wound closure. The cultures obtained from patients using preoperative antibiotics were positive for S. aureus in 10% (n = 2) of cases, and positive in 8.33% (n = 1) of cases not using antibiotics. The mean transoperative time with positive growth was 67 ± 17.8 minutes, and with negative growth was 76.3 ± 25.2 minutes. Two surgical techniques were evaluated: phacoemulsification and extracapsular extraction. The extracapsular technique showed a contamination rate of 33.33% (n = 8) compared to phacoemulsification with a rate of 25% (n = 2) (RR = 1.33).
Conclusions:
Common contaminating microorganisms included the Staphylococcus species, which was isolated from the eyelids and ocular annexes at the time of wound closure. The isolation of microorganisms postoperatively could have been influenced by the surgical technique used, the surgical time, and the use of antibiotics.
Insights
Postoperative endophthalmitis risk factors were evaluated in cataract surgery. Staphylococcus species were common contaminants, influenced by surgical technique and antibiotic use, highlighting the need for improved aseptic protocols.
Area of Science:
- Ophthalmology
- Infectious Disease
- Surgical Safety
Background:
- Postoperative endophthalmitis, though rare (<0.01%), has severe consequences.
- Identified infection sources include air, solutions, instruments, IOLs, and wound leakage.
- Optimizing aseptic techniques is crucial for reducing infection risk.
Purpose of the Study:
- To evaluate surgical techniques, antibiotic use, and aseptic measures in cataract surgery.
- To identify key factors contributing to postoperative infection.
- To inform strategies for minimizing endophthalmitis risk.
Main Methods:
- Prospective study of 64 cataract surgeries in 32 patients over 1 month.
- Analysis of preoperative and postoperative aspirate cultures.
- Comparison of outcomes with and without preoperative antibiotics.
Main Results:
- Postoperative cultures were positive in 31.25% of cases, with Staphylococcus species being most common.
- Extracapsular extraction had a higher contamination rate (33.33%) than phacoemulsification (25%).
- Preoperative antibiotics showed a trend towards lower S. aureus isolation.
Conclusions:
- Staphylococcus species, often from ocular adnexa, are common contaminants.
- Surgical technique, duration, and antibiotic use influence postoperative microbial isolation.
- Enhanced aseptic protocols are essential for preventing endophthalmitis.
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