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[Bacterial colonization of conjunctiva with Propionibacterium acnes before and after polyvidon iodine administration
C Binder1, H M de Kaspar, M Engelbert
1Augenklinik, Ludwig-Maximilians-Universität München.
Background:
Propionibacterium acnes has been described as a causative agent of postoperative endophthalmitis. This gram-positive, immotile, non-spore-forming bacterium is highly pleomorphic and grows under conditions of low to no oxygen concentration. It is commonly found on the skin at the openings of sebaceous glands and on hairs. A near-symptomless postoperative endophthalmitis occurs particularly when Propionibacteria are enclosed in the capsular bag. We investigated to what extent the number of P. acnes in the conjunctival sac can be reduced by preoperative disinfection with polyvidone iodine (1%).
Patients And Methods:
A total of 261 patients with intrabulbar surgery had two conjuctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after disinfection with polyvidone iodine before opening the conjunctiva.
Results:
Of the 261 swabs, 60 (23%) taken prior to polyvidone iodine application were positive for Propinibacterium acnes. Following polyvidone iodine treatment, a further 5 (1.9%) remained culture-positive. After disinfection, 55 (92%) of the 60 positive swabs for Propionibacterium acnes remained culture-negative.
Conclusions:
We concluded that a significant reduction of P. acnes can be achieved by preoperative application of polyvidone iodine (1%) (P < 0.001).
Insights
Preoperative disinfection with 1% polyvidone iodine significantly reduces Propionibacterium acnes (P. acnes) in the conjunctival sac, lowering the risk of postoperative endophthalmitis.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Infection Prevention
Background:
- Propionibacterium acnes (P. acnes) is a Gram-positive bacterium implicated in postoperative endophthalmitis.
- P. acnes thrives in low-oxygen environments and is commonly found on skin and hair follicles.
- Enclosed P. acnes within the capsular bag can lead to near-symptomless endophthalmitis.
Purpose of the Study:
- To evaluate the efficacy of 1% polyvidone iodine in reducing P. acnes in the conjunctival sac before intrabulbar surgery.
Main Methods:
- 261 patients undergoing intrabulbar surgery provided two conjunctival swabs.
- The first swab was taken preoperatively after antibiotic eye drops.
- The second swab was collected after 1% polyvidone iodine disinfection.
Main Results:
- 23% (60/261) of initial swabs were positive for P. acnes.
- After polyvidone iodine disinfection, 92% (55/60) of initially positive swabs became culture-negative.
- Only 1.9% (5/261) of swabs remained positive post-disinfection.
Conclusions:
- Preoperative application of 1% polyvidone iodine significantly reduces P. acnes levels.
- This disinfection method is effective in minimizing bacterial load prior to ocular surgery.
- A statistically significant reduction (P < 0.001) was observed.