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Effect of Prophylactic Topical Antibiotics on Rates of Infectious Complications After Strabismus Surgery: A Large
Natalia M Binczyk1, Euna B Koo1, Scott R Lambert1
1From the Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
Objective:
Not all strabismus surgeons use prophylactic topical antibiotics postoperatively because they may be poorly tolerated, costly, and may increase antimicrobial resistance. The purpose of the study is to assess the effect of postoperative topical antibiotics on the rate of surgical site infections following strabismus surgery.
Design:
Retrospective clinical cohort study.
Participants:
Patients who underwent strabismus surgery in the past 20 years. Patients who were or were not prescribed postoperative topical antibiotics comprised the study and control groups, respectively.
Methods:
This study was conducted using data from TriNetX, an international electronic health-record registry containing data for over 130 million patients. Strabismus surgery patients were identified using CPT codes. The prescription of eye topical antibiotics and the frequency of surgical site infections were identified by RxNorm and ICD-10 codes, respectively. Analysis was conducted using the measures of association feature of TriNetX. Patient demographics such as age, sex, and race were recorded based on their presence in the electronic records system.
Main Outcome Measure:
Development of endophthalmitis, orbital and preseptal cellulitis.
Results:
There were 84,052 patients who underwent strabismus surgery. 38,484 (46%) patients received 1 or more postoperative topical antibiotics. About 70% of the patients were White and 10% Black. There was a slight female preponderance (51%). Endophthalmitis developed in 16 patients (0.019%), orbital cellulitis in 24 patients (0.029%) and preseptal cellulitis in 55 patients (0.065%). There was no difference in the rates of endophthalmitis, orbital, and preseptal cellulitis between the groups (p values 0.855, 0.684, 0.925 respectively).
Conclusions:
The prescription of prophylactic topical antibiotics did not decrease rates of surgical site infections following strabismus surgery. Administering postoperative topical antibiotics can be distressing to children, costly, and may contribute to antimicrobial resistance. Given no clear advantage and potential disadvantages, the use of postoperative topical antibiotics following strabismus surgery may not be beneficial.
Insights
Postoperative topical antibiotics do not reduce surgical site infections after strabismus surgery. Their use may cause distress and increase antimicrobial resistance, suggesting they may not be beneficial.
Area of Science:
- Ophthalmology
- Infectious Disease
Background:
- Prophylactic topical antibiotics are not universally used after strabismus surgery due to potential side effects and concerns about antimicrobial resistance.
- The efficacy of postoperative topical antibiotics in preventing surgical site infections (SSIs) following strabismus surgery remains unclear.
Purpose of the Study:
- To evaluate the impact of postoperative topical antibiotic use on the incidence of SSIs after strabismus surgery.
Main Methods:
- Retrospective cohort study utilizing the TriNetX electronic health record registry (over 130 million patients).
- Identified 84,052 patients who underwent strabismus surgery.
- Compared SSI rates (endophthalmitis, orbital cellulitis, preseptal cellulitis) between patients who received postoperative topical antibiotics and those who did not, using CPT, RxNorm, and ICD-10 codes.
Main Results:
- Of 84,052 patients, 38,484 (46%) received postoperative topical antibiotics.
- No statistically significant difference in the rates of endophthalmitis (0.019%), orbital cellulitis (0.029%), or preseptal cellulitis (0.065%) was observed between the antibiotic and no-antibiotic groups (p > 0.05 for all).
Conclusions:
- Postoperative topical antibiotic administration did not lower SSI rates in strabismus surgery patients.
- The potential disadvantages, including patient distress, cost, and contribution to antimicrobial resistance, outweigh the lack of demonstrated benefit.
- Discontinuation of routine prophylactic topical antibiotics following strabismus surgery may be considered.
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