Alergia a antibióticos Beta-lactámicos en cirugía de cataratas. Prevalencia y características preoperatorias de los pacientes alérgicos / Beta-lactamic antibiotics allergy in cataract surgery. Prevalence and preoperative characteristics of allergic patients

OBJETIVO: Describir la proporción de pacientes alérgicos a antibióticos β-lactámicos y su flora conjuntival entre los admitidos a cirugía de cataratas en nuestro entorno. MÉTODO: Estudio retrospectivo transversal de prevalencia de pacientes alérgicos a β-lactámicos admitidos consecutivamente a cirugía de cataratas del 11 de julio de 2005 al 13 de noviembre de 2012. Para estudiar la prevalencia de bacterias conjuntivales y de características clínicas en el examen preoperatorio de los pacientes se excluyeron los menores de 18 años y aquellos con operaciones de cataratas combinadas con otras cirugías oculares, seleccionando los datos del primer preoperatorio de los pacientes restantes. Los datos clínicos se extrajeron de la base de datos generada en la consulta de evaluación para anestesia, y los microbiológicos de la base de datos del laboratorio. Ambas bases se vincularon mediante el código de historia clínica. Se comparó la prevalencia de bacterias conjuntivales y de características clínicas entre alérgicos y no-alérgicos. RESULTADOS: De 12.409 adultos seleccionados para estudio bacteriano, 862 (6,96%) eran alérgicos a β-lactámicos, su edad media era de 74,45 años, superior a la de los no-alérgicos (p = 0,005). En los alérgicos la proporción de mujeres (71,4%) fue muy superior a la de hombres. La prevalencia de bacterias patógenas (especialmente Bacillus spp. y Pseudomonas aeruginosa), enfermedades pulmonares e insuficiencia cardiaca fue mayor en los alérgicos. CONCLUSIONES: La prevalencia de alérgicos a β-lactámicos de este estudio está comprendida en el rango descrito en otras poblaciones. La mayor prevalencia de bacterias patógenas y el predominio de mujeres en los alérgicos a β-lactámicos son datos útiles para pautar su profilaxis quirúrgica

OBJECTIVE: To describe the proportion of patients allergic to β-lactam antibiotics and the prevalence of preoperative conjunctival bacteria among those undergoing cataract surgery in our area. METHOD: Retrospective cross-sectional study of prevalence of β-lactam allergic patients consecutively scheduled for cataract surgery from 11 July 2005 to November 2012. For studying the prevalence of conjunctival bacteria and clinical characteristics in the patients' preoperative examination, those under 18 years and those with cataract surgery combined with other eye surgeries were excluded. Data from the first preoperative examination of the remaining patients were selected. Clinical data were extracted from the database generated in the evaluation made for anesthetic purposes, and the microbiological data from the laboratory database. Both bases were linked through a patient history code. A comparison was made between the prevalence of conjunctival bacteria and clinical characteristics in allergic and non-allergic patients. RESULTS: From 12,409 adults selected for the bacteriological study, 862 (6.96%) were allergic to β-lactams, their mean age (74.45 years) was higher than that of the non-allergic (P = 0.005). The proportion of women (71.4%) in the allergic patient group was much higher than that of men. The prevalence of pathogenic bacteria (especially Bacillus spp and Pseudomonas aeruginosa), lung disease and heart failure, was higher in allergic patients. CONCLUSIONS: The prevalence of allergy to β-lactams in this study is within the range described in other populations. The higher prevalence of pathogenic bacteria and the predominance of women in those allergic to β-lactams are useful data to guide their surgical prophylaxis

[Beta-lactamic antibiotics allergy in cataract surgery. Prevalence and preoperative characteristics of allergic patients]. / Alergia a antibióticos ß-lactámicos en cirugía de cataratas. Prevalencia y características preoperatorias de los pacientes alérgicos.

OBJECTIVE: To describe the proportion of patients allergic to ß-lactam antibiotics and the prevalence of preoperative conjunctival bacteria among those undergoing cataract surgery in our area. METHOD: Retrospective cross-sectional study of prevalence of ß-lactam allergic patients consecutively scheduled for cataract surgery from 11 July 2005 to November 2012. For studying the prevalence of conjunctival bacteria and clinical characteristics in the patients' preoperative examination, those under 18 years and those with cataract surgery combined with other eye surgeries were excluded. Data from the first preoperative examination of the remaining patients were selected. Clinical data were extracted from the database generated in the evaluation made for anesthetic purposes, and the microbiological data from the laboratory database. Both bases were linked through a patient history code. A comparison was made between the prevalence of conjunctival bacteria and clinical characteristics in allergic and non-allergic patients. RESULTS: From 12,409 adults selected for the bacteriological study, 862 (6.96%) were allergic to ß-lactams, their mean age (74.45 years) was higher than that of the non-allergic (P=.005). The proportion of women (71.4%) in the allergic patient group was much higher than that of men. The prevalence of pathogenic bacteria (especially Bacillus spp and Pseudomonas aeruginosa), lung disease and heart failure, was higher in allergic patients. CONCLUSIONS: The prevalence of allergy to ß-lactams in this study is within the range described in other populations. The higher prevalence of pathogenic bacteria and the predominance of women in those allergic to ß-lactams are useful data to guide their surgical prophylaxis.

Espectro y susceptibilidad de las bacterias conjuntivales preoperatorias / Spectrum and susceptibility of preoperative conjunctival bacteria

Objetivo: Describir el espectro bacteriano conjuntival de nuestros pacientes admitidos a cirugía intraocular y la sensibilidad a antibióticos en el periodo estudiado. Métodos: Estudio retrospectivo del cultivo conjuntival preoperatorio de pacientes consecutivos programados para cirugía intraocular del 21 de febrero de 2011 al 1 de abril de 2013. Las muestras se sembraron directamente en agar-sangre y agar-MacConkey (incubación, 2 días en aerobiosis), y en agar-chocolate (incubación, 7 días con 6% CO2). Las bacterias identificadas se dividieron en tres grupos según su origen, realizándose antibiograma a las más patogénicas y a algunas menos patogénicas cuando se aislaban más de cinco colonias. La sensibilidad de bacterias de crecimiento exigente se obtuvo con técnica de difusión en disco y la de bacterias no-exigentes determinando su concentración mínima inhibitoria. Resultados: En 6.051 cultivos, se identificaron 13.203 bacterias; el 88,7% eran típicas colonizadoras de conjuntiva (grupo 1); el 8,8%, típicas de vías respiratorias (grupo 2); el 2,5% restante, de origen indeterminado (grupo 3). Un total de 530 muestras (8,8%) fueron estériles. La sensibilidad del grupo 1 fue: vancomicina 99%, rifampicina 95%, cloranfenicol 87%, tetraciclina 76%; los niveles de cotrimoxazol, aminoglucósidos, quinolonas, β-lactámicos y macrólidos decrecieron desde 2007. El grupo 2 fue muy sensible a cloranfenicol, cefuroxima, cefotaxima, rifampicina, ciprofloxacina y amoxicilina-clavulanato. En grupo 3, levofloxacina 93%, ciprofloxacina 89%, tobramicina 76%; pero ceztazidima 53% y cefuroxima 29% decrecieron. Conclusiones: Ninguno de los antibióticos probados puede eliminar todas las bacterias conjuntivales. Aquellas que viven permanentemente en la conjuntiva (grupo 1) han adquirido mayor resistencia que los colonizadores eventuales (AU)

Purpose: To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. Methods: A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. Results: A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, β-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. Conclusions: None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers (AU)

[Spectrum and susceptibility of preoperative conjunctival bacteria]. / Espectro y susceptibilidad de las bacterias conjuntivales preoperatorias.

PURPOSE: To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. METHODS: A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. RESULTS: A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, ß-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. CONCLUSIONS: None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers.

Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery.

PURPOSE: To identify the risk of patients undergoing cataract surgery of having pathogenic conjunctival bacteria associated with their systemic co-morbidities. METHODS: Retrospective study of consecutive patients undergoing their first cataract operation from July 2005 to April 2010. Their preoperative conjunctival bacteria were cultured, identified, and classified in bacterial groups. Their co-morbidities were defined from their clinical data and the answers to systematic questions asked in the anaesthetic evaluation. The Microsoft Access databases of the two data sets were merged for carrying out the statistical analysis. Univariate association of each bacterial group with each co-morbidity was studied by using χ(2)-test for categorical data and Student's t-test for continuous variables. Also, logistic regression models were used adjusting for age and sex. SPSS statistic programme, version 18 was used for all these analyses. Endophthalmitis cases in this surgical series were searched. RESULTS: In the 8333 selected patients, age was associated with increased conjunctival bacteria in all groups except for Streptococcus pneumoniae and Propionibacteriae. However, male sex was associated with these two groups and also with coagulase-negative Staphylococci, Corynebacterium xerosis, Staphylococcus aureus, and Gram-negative rods. After adjusting for age and sex, S. aureus was associated with diabetes, lung diseases, and renal and heart insufficiency; Gram-negative rods with smoking habit; Enterococci with diabetes; Streptococcus pneumoniae with kyphoscoliosis; and other Streptococci with diabetes and handicapped patients. CONCLUSION: The more pathogenic conjunctival bacteria were more likely associated with patients' co-morbidities, such as diabetes, lung diseases, renal and heart insufficiency, kyphoscoliosis, and smoking habit, than the less pathogenic ones.

The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis.

PURPOSE: To assess the prevalence of the antibiotics resistant conjunctival bacteria in order to adapt our cataract surgery prophylaxis to the new prophylaxis techniques. METHODS: Observational prospective study of preoperative conjunctival cultures of consecutive patients undergoing cataract surgery during a year. Patients having eye surgical prophylaxis in the previous 6 months were excluded. The aerobiosis and microaerobiosis incubation lasted 2 and 7 days, respectively. Three profiles of identification and antibiotics sensibility tests were used. The data recorded on the Autoscan4 were exported to a Microsoft Access database. Statistical calculations were carried out with the Epidat program, 3.1 version. RESULTS: Of 4391 microbes isolated, 94.2% bacteria were Gram-positive and 5.3% Gram-negative. In the 1940 selected patients, their prevalence was coagulase-negative Staphylococci (CNS) 88.3%, Diphtheroids 58.1%, Propionibacteria 31%, Streptococci 23.1%, Staphylococcus aureus 10.2%, Haemophilus plus Gram-negative diplococci 7.5%, other Gram-negative rods 4.5%, Enterococci 2%. The Enterococci-Staphylococci profile was the most resistant (erythromycin 47.4%, methicillin 42.8%, ciprofloxacin 23.1%, tetracycline 18.4%, gentamicin 15.7%, levofloxacin 15.1%, tobramycin 14.8%, ..., chloramphenicol 3.7%, rifampicin 1.6%, and fusidic-acid 0.6%). The typical respiratory bacteria remained sensitive to chloramphenicol and beta-lactams. Other Gram-negative rods were sensitive to aminoglucosides, quinolones, and certain beta-lactams. CONCLUSIONS: None of the antibiotics tested here, including cefuroxime and levofloxacin, was active against the whole isolated conjunctival bacteria of our patients. On the basis of our resistance patterns and other prophylaxes effects, two phases of local prophylaxis are suggested: first, eliminating Staphylococci and respiratory bacteria with rifampicin or chloramphenicol, preoperatively; second, giving levofloxacin from 1 h before surgery until 6 days afterwards.

[Chronic carriers of pathogen conjunctival bacteria. Possible risks in cataract surgery]. / Portadores crónicos de bacterias conjuntivales patógenas. Posible riesgo en la cirugía de cataratas.

PURPOSE: To ascertain the frequency and characteristics of chronic carriers of conjunctival pathogen bacteria among patients undergoing cataract surgery in our hospital, to allow the design of studies of their postsurgical endophthalmitis risk. METHODS: Retrospective study of the preoperative conjunctival flora of 784 patients operated on for cataracts in both eyes, in two operations separated by 213 days (SD 170), from November 1993 to December 1997. Results of both cultures for each patient were obtained from the Laboratory cataract preoperative database, by means of an auxiliary utility in dBASE-III-PLUS program. The preoperative bacteria in both surgeries were compared and the patients having the same pathogen bacteria (all except Staphylococcus coagulase negative and Corynebacterium sp.) were identified. The mean values and standard deviations were calculated using Epiinfo 6.04, and the Chi2 test was carried out using Excel 97. RESULTS: The conjunctival flora stemming from the first preoperative culture of the 784 patients were statistically similar to those of our reference population. The pathogen bacteria decreased in the second preoperative culture; especially the Streptococcus Pneumoniae and Haemophilus sp. frequencies (p<0.05). The same pathogen was isolated in both cultures of 31 patients among the 784 who entered the study, Staphylococcus Aureus and Proteus Mirabilis being the most frequent colonizers. The mean age of those carriers was higher than the mean age of the reference population (p<0.01). CONCLUSIONS: 3.95% of our patients awaiting cataract surgery are usual conjunctival carriers of certain pathogen bacteria; this finding is associated with the age of the patients and possibly with some pre-existing diseases.

Portadores crónicos de bacterias conjuntivales patógenas: Posible riesgo en la cirugía de cataratas / Chronic carriers of pathogen conjutival bacteria. Possible risks in cataract surgery

Objetivo: Conocer la frecuencia y características de los portadores crónicos de bacterias patógenas conjuntivales entre los pacientes que se operan de cataratas, para diseñar estudios de su riesgo de endoftalmitis postquirúrgica. Métodos: Estudio retrospectivo de la flora conjuntival preoperatoria de 784 pacientes operados de las cataratas de ambos ojos en dos cirugías, separadas por 213 días (DE =170), desde noviembre de 1993 a diciembre de 1997. Los resultados de los cultivos de ambas cirugías, se obtuvieron de la base de datos de preoperatorios de cataratas del Laboratorio, mediante programa auxiliar en dBASE-III-PLUS. Se compararon las frecuencias de bacterias de ambos preoperatorios y se identificaron los pacientes que tenían el mismo patógeno (todas las bacterias excepto Staphylococcus Epidermidis y Corynebacterium sp.)en las dos cirugías. Los valores medios y desviaciones típicas se calcularon con Epiinfo 6.04, y las pruebas Chi2 con Excel 97. Resultados: La flora del primer preoperatorio en los 784 pacientes fue estadísticamente igual que en nuestra población de referencia. Las bacterias patógenas disminuyeron en el segundo preoperatorio; sobretodo las frecuencias de Streptococcus Pneumoniae y Haemophilus sp. (p<0,05). En 31 de los 784 pacientes, se aisló el mismo patógeno en los dos preoperatorios, siendo Staphylococcus Aureus y Proteus Mirabilis los colonizadores más frecuentes. La edad media de los portadores era superior (p<0,01) a la de la media de la población de referencia. Conclusiones: El 3,95% de nuestros pacientes con cataratas son portadores crónicos de determinadas bacterias patógenas conjuntivales; este hallazgo se asocia con la edad y posiblemente con patologías preexistentes(AU)

Purpose: To ascertain the frequency and characteristics of chronic carriers of conjunctival pathogen bacteria among patients undergoing cataract surgery in our hospital, to allow the design of studies of their postsurgical endophthalmitis risk. Methods: Retrospective study of the preoperative conjunctival flora of 784 patients operated on for cataracts in both eyes, in two operations separated by 213 days (SD 170), from November 1993 to December 1997. Results of both cultures for each patient were obtained from the Laboratory cataract preoperative database, by means of an auxiliary utility in dBASE-III-PLUS program. The preoperative bacteria in both surgeries were compared and the patients having the same pathogen bacteria (all except Staphylococcus coagulase negative and Corynebacterium sp.) were identified. The mean values and standard deviations were calculated using Epiinfo 6.04, and the Chi2 test was carried out using Excel 97. Results: The conjunctival flora stemming from the first preoperative culture of the 784 patients were statistically similar to those of our reference population. The pathogen bacteria decreased in the second preoperative culture; especially the Streptococcus Pneumoniae and Haemophilus sp. frequencies (p<0.05). The same pathogen was isolated in both cultures of 31 patients among the 784 who entered the study, Staphylococcus Aureus and Proteus Mirabilis being the most frequent colonizers. The mean age of those carriers was higher than the mean age of the reference population (p<0.01). Conclusions: 3.95% of our patients awaiting cataract surgery are usual conjunctival carriers of certain pathogen bacteria; this finding is associated with the age of the patients and possibly with some pre-existing diseases(AU)

[Preoperative eye-drop antibiotherapy in cataract surgery]. / Antibioterapia tópica preoperatoria en la cirugía de cataratas.

OBJECTIVE: To ascertain the effectiveness of various antibiotic eye-drops in eradicating the preoperative conjunctival bacteria of patients undergoing cataract surgery and to differentiate the failure of these treatments due to the lack of "in vitro" sensibility from other possible causes. METHODS: Retrospective study of the preoperative conjunctival flora of 4876 consecutive patients; "in vitro" sensibility was analysed by grouping bacteria into eight categories; the susceptibility percentages of the total conjunctival flora to five antibacterial agents were compared. The effectiveness of the eye-drop treatment with a single sensitive tested antibiotic (Aureomicin, Chloramphenicol, Gentamicin, Norfloxacin or Rifamicin) was evaluated in patients with pathogen bacteria. RESULTS: The "in vitro" sensibilities of Chloramphenicol (84.4%) and Rifampicin (83.9%) were similar (p < 0.01) and statistically higher than those of the other antibiotics. Nevertheless, the Chloramphenicol pathogen bacterium treatment failed in 21.2% of cases, in spite of being "in vitro" sensitive. Gentamicin presented the best effectiveness for eradicating Staphylococcus aureus and Gram (-) rods. Aureomicin had the best effectiveness against Streptococcus and Gram (-) diplococci. Rifamicin was the most effective for eradicating the whole predominant Gram (+) flora. The effectiveness of all five antibiotics decreased when there was more than one pathogen. CONCLUSIONS: None of the five antibiotic monotherapies maintains the patients' conjunctive free of pathogen bacteria 48 hours after finishing the treatment; however, there are bacterial patrons whose treatment could be optimised. The existence of polymicrobial flora decreases the effectiveness of the treatment.