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Lacrimal-duct-probing-induced bacteremia: should children with congenital heart defects receive antibiotic
G A Eippert1, R A Burnstine, J H Bates
1Summa Health System, Akron, Ohio, USA.
Insights
Lacrimal-duct probing in children can cause bacteremia (bacteria in the bloodstream), with a 17.5% infection rate observed. This suggests antibiotic prophylaxis may be prudent for high-risk children to prevent infectious endocarditis (IE).
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Bacteremia following medical procedures is a concern, particularly in children.
- Infectious endocarditis (IE) is a serious infection, though less common in pediatric populations.
- Lacrimal-duct probing is a common pediatric ophthalmology procedure.
Purpose of the Study:
- To determine the incidence of bacteremia after lacrimal-duct probing in children.
- To evaluate the necessity of antibiotic prophylaxis for children at high risk of IE.
Main Methods:
- Prospective study of 40 children undergoing lacrimal-duct probing.
- Preoperative lacrimal and blood cultures were obtained.
- Postoperative cultures assessed for transient bacteremia.
Main Results:
- An overall infection rate of 17.5% (7 of 40 children) was observed.
- Common pathogens included Haemophilus influenzae (10.0%) and Streptococcus pneumoniae (7.5%).
- One case involved Streptococcus viridans.
Conclusions:
- Lacrimal-probe-induced bacteremia occurs with significant incidence.
- Organisms identified are known etiological agents for IE in children.
- Antibiotic prophylaxis is recommended for high-risk pediatric patients undergoing this procedure.
Purpose:
To determine the incidence of bacteremia following lacrimal-duct probing in children, and to evaluate the potential need for antibiotic prophylaxis in children who are at an increased risk of infectious endocarditis (IE).
Methods:
In a prospective study beginning in October 1994, 40 consecutive children requiring lacrimal-duct probing performed by a single pediatric ophthalmologist received preoperative lacrimal and blood cultures followed by postoperative probe-induced transient bacteremia that was defined as a negative preoperative blood culture, followed by a positive postoperative blood culture of the same bacteria identified in the positive lacrimal culture.
Results:
The overall infection rate as described above was 7 of 40 children (17.5%) with a 95% confidence interval of 7.3% to 32.8%. Of these, four children had positive postoperative cultures for Haemophilus influenzae (10.0%) and 3 were positive for Streptococcus pneumoniae (7.5%) One child had a negative preoperative blood and lacrimal culture with a postoperative blood culture positive for Streptococcus viridans.
Conclusions:
This study shows a significant incidence of lacrimal-probe-induced bacteremia with organisms that have been documented as etiological agents for IE in children. IE, although less common in children, remains a serious, potentially life threatening infection with high mortality. Although lacrimal-duct probing has never been clearly associated with documented endocarditis, it is the authors' recommendation that it be prudent for patients who are at known high risk for endocarditis to receive SBE prophylaxis considering the low cost/benefit ratio.
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