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 conjunctival bacterial pattern of diabetics undergoing cataract surgery.

PURPOSE: To ascertain the conjunctival bacterial pattern of diabetics undergoing cataract operation to reduce the risk of postoperative endophthalmitis (PE). METHODS: An observational retrospective study of the conjunctival bacteria of consecutive patients undergoing cataract surgery from July 2005 to November 2008. Records of patients having eye surgical prophylaxis in the 6 months before the culture and those patients having cataract operation combined with other surgical procedures were excluded. Aerobic and microaerobic cultures were carried out. Dade-Behring panels were used for bacterial identification. The database containing the isolated bacteria was linked to another Access database containing demographic and clinical data such as diabetes presence and baseline blood glucose and creatinine levels. The conjunctival bacteria of diabetics were compared with those of the non-diabetics. Epidat 3.1 program was used for statistical calculations. RESULTS: From 5922 selected patients, 1325 (22.37%) knew they were diabetics (higher prevalence than expected). Among self-reported non-diabetics, 900 (15.2%) could be 'unknown' diabetics; another 274 had an impaired renal function; and 3423 non-diabetics joined the control group. Diabetics have a significantly higher prevalence of Staphylococcus aureus, Enterococci, certain Streptococci, and Klebsiella sp. than non-diabetics. Diabetics and non-diabetics having a blood creatinine level above 105.2 mumol/l had an increased conjunctival bacterial prevalence; these groups had a higher mean age and men predominated. CONCLUSIONS: Diabetics have a conjunctival flora pattern whose increased bacteria are a predominant cause of many diabetic infections. An abnormally high blood creatinine level is an indicator of increased conjunctival colonisation in diabetics and non-diabetics.

[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.

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

Objetivo: Conocer la efectividad de varios antibióticos en colirio para eliminar la flora conjuntival de los pacientes que se operan de cataratas y diferenciar los fracasos del tratamiento debidos a la falta de sensibilidad "in vitro" de las bacterias, de otras posibles causas. Método: Estudio retrospectivo de la flora conjuntival preoperatoria de 4.876 pacientes consecutivos; análisis de su sensibilidad "in vitro" agrupando las bacterias en ocho categorías; comparación de los porcentajes de susceptibilidad de la flora total a 5 antimicrobianos. Evaluación de la eficacia de los tratamientos con colirio de un solo antibiótico (Aureomicina, Cloranfenicol, Gentamicina, Norfloxacina ó Rifamicina), de sensibilidad probada, en los pacientes con bacterias conjuntivales patógenas. Resultados: La sensibilidad "in vitro" de nuestra flora a Rifampicina (83,9 por ciento) y Cloranfenicol (84,4 por ciento) fue similar (p<0,01) y significativamente superior que a los otros tres antibióticos. Pero, el tratamiento de las bacterias patógenas con Cloranfenicol fracasó en el 21,2 por ciento de los casos, aún siendo sensibles "in vitro" a él. Gentamicina fue el más eficaz para tratar Staphylococcus Aureus y bacilos Gram (—). Aureomicina el más eficaz contra Streptococcus y diplococos Gram (—). Rifamicina fue el más eficaz para erradicar la predominante flora Gram (+). La eficacia de los tratamientos disminuyó cuando la flora era polibacteriana. Conclusiones: Ninguno de los 5 antibióticos, en monoterapia, fue eficaz para mantener la conjuntiva libre de la flora patógena en todos los pacientes, 48 horas después del tratamiento; pero se detectan patrones bacterianos de tratamiento optimizable. La existencia de flora polimicrobiana disminuyó la eficacia del tratamiento (AU)

[Trabeculectomy and phacoemulsification. One site vs. two site approach. A comparative study]. / Trabeculectomía asociada a facoemulsificación. Incisión única frente a doble incisión independiente: estudio comparativo.

PURPOSE: To compare the results of combined phacotrabeculectomy by means of a one-site versus two-site approach. MATERIALS AND METHODS: A retrospective study has been performed over 35 glaucomatous patients with a coexisting cataract, treated with a one-site (19 cases) or a two-site (16 cases) phacotrabeculectomy. First, effectiveness of both procedures has been proved by statisticly analysing the IOP and visual acuity changes after surgery. Normal distribution, homogeneity and homocedasticity from both groups have been checked. Finally, visual acuity and 6-month postoperatively IOP among both groups have been compared by means of a <>. RESULTS: No statistical differences among both procedures have been found (p>0.05). Also, postoperative complications were similar among groups. CONCLUSIONS: Combined trabeculectomy and phacoemulsification surgery is a useful treatment for glaucomatous patients with coexisting cataract, and provides good visual and ocular-pressure results. One-site and two-site surgical approachs provide the same six-month follow-up results.

Trabeculectomía asociada a facoemulsificación. Incisión única frente a doble incisión independiente: estudio comparativo / Trabeculectomy and phacoemulsification. One site vs. Two site approach. A comparative study

Objetivo: Comparar los resultados de la faco-trabeculectomía realizada mediante una única incisión frente a la realizada mediante dos incisiones independientes. Material y métodos: Se realiza un estudio retrospectivo de 35 pacientes diagnosticados de glaucoma crónico y catarata, intervenidos mediante facotrabeculectomía por vía única (n=19) o por dos vías independientes (n= 16). En primer lugar se verifica la eficacia de ambas técnicas analizando estadísticamente las variaciones de PIO y agudeza visual, y se comprueba en ambas muestras normalidad, homogeneidad y homocedasticidad. Posteriormente se compara la agudeza visual y la PIO a los seis meses de la cirugía entre los dos grupos mediante test de diferencia de medias de t de Student para muestras independientes. Conclusión: La facotrabeculectomía es una opción terapéutica eficaz para pacientes glaucomatosos afectos de catarata, con buenos resultados visuales y tensionales. La utilización de una única incisión o dos independientes en el abordaje de la técnica aporta los mismos resultados a los seis meses (AU)