1
|
Dupré R, Baillif S, Lotte R, Ruimy R, Lagier J, Berrouane Y, Gawdat T, Fendri M, Martel A. Is topical antibiotic use necessary to prevent surgical site infection following oculoplastic surgery? Graefes Arch Clin Exp Ophthalmol 2024; 262:3331-3343. [PMID: 38643423 DOI: 10.1007/s00417-024-06489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a "100% antibiotic free" fashion. METHOD We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher's exact test. The alpha risk was set to 5% and two-tailed tests were used. RESULTS Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups (p = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups (p = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI (p = 0.002). CONCLUSION This study suggests that performing a "100% antibiotic free" oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.
Collapse
Affiliation(s)
- Robin Dupré
- Ophtalmology department, Pasteur 2 Hospital, University Hospital of Nice, 30 Voie Romaine CS 51069 - 06001, Cedex 1, Nice, France
| | - Stéphanie Baillif
- Ophtalmology department, Pasteur 2 Hospital, University Hospital of Nice, 30 Voie Romaine CS 51069 - 06001, Cedex 1, Nice, France
| | - Romain Lotte
- Department of Bacteriology, University Hospital of Nice, Nice, France
| | - Raymond Ruimy
- Department of Bacteriology, University Hospital of Nice, Nice, France
| | - Jacques Lagier
- Ophtalmology department, Pasteur 2 Hospital, University Hospital of Nice, 30 Voie Romaine CS 51069 - 06001, Cedex 1, Nice, France
| | - Yasmina Berrouane
- Infection Prevention and Control Department, Cimiez Hospital, University Hospital of Nice, Nice, France
| | - Tamer Gawdat
- Ophthalmology department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mehdi Fendri
- Ophtalmology department, Private activity at Taoufik Hospital Group, Tunis, Tunisia
| | - Arnaud Martel
- Ophtalmology department, Pasteur 2 Hospital, University Hospital of Nice, 30 Voie Romaine CS 51069 - 06001, Cedex 1, Nice, France.
| |
Collapse
|
2
|
Tang XF, Bin X, Qu KY, Liu HJ, Lei H, Li WF, Min Z, Xia Y, Dai LH, Yu SY, Bao YP, Zhu JQ, Bing T. Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis. Int J Surg 2024; 110:5818-5832. [PMID: 38935088 PMCID: PMC11392186 DOI: 10.1097/js9.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial. METHODS The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery. RESULTS A total of 16 189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients' length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability. CONCLUSION Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.
Collapse
Affiliation(s)
- Xiao-Fei Tang
- Department of Pharmaceutical, Fengdu People's Hospital, Chongqing
| | - Xiang Bin
- Department of Otolaryngology, Fengdu People's Hospital, Chongqing
| | - Ke-Yi Qu
- Department of Stomatology, Fengdu People's Hospital, Chongqing
| | - Hong-Jun Liu
- Department of Cardiovascular, Fengdu People's Hospital, Chongqing
| | - Haike Lei
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing
| | - Wei-Fan Li
- Department of Pharmaceutical, Fengdu People's Hospital, Chongqing
| | - Zhou Min
- Department of Education, Fengdu People's Hospital & Science, Chongqing
| | - Yu Xia
- Department of Education, Fengdu People's Hospital & Science, Chongqing
| | - Li-Hua Dai
- Department of Pharmaceutical, Fengdu People's Hospital, Chongqing
| | - Su-Ying Yu
- Department of Nursing, Fengdu People's Hospital, Chongqing
| | - Yun-Ping Bao
- Department of Stomatology, Fengdu People's Hospital, Chongqing
| | - Jia-Quan Zhu
- Department of Pharmaceutical, Fengdu People's Hospital, Chongqing
| | - Tan Bing
- Department of Medical Equipment, Fengdu People's Hospital, Chongqing, China
| |
Collapse
|
3
|
Rukyaa J, Temba L, Kachira P, Mwanansao C, Seni J. Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania. BMC Res Notes 2024; 17:193. [PMID: 38992706 PMCID: PMC11241939 DOI: 10.1186/s13104-024-06851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Understanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023. RESULTS The study participants had a median age of 62.5 (interquartile range: 39.5-75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. Staphylococcus epidermidis [43.4% (n = 85)], Staphylococcus aureus [21.9% (n = 43)] and Pseudomonas aeruginosa [14.3% (n = 28)] were the most common bacteria. There were low proportions of resistance among predominant Gram-positive and Gram-negative bacteria to gentamicin (≤ 25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3rd generation cephalosporins (≤ 25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0-66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management.
Collapse
Affiliation(s)
- Johannes Rukyaa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Lillian Temba
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Princekened Kachira
- Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Christopher Mwanansao
- Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
- Department of Ophthalmology, Bugando Medical Centre, P.O.Box 1370, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania.
| |
Collapse
|
4
|
Lin WL, Wu LM, Nguyen THY, Lin YH, Chen CJ, Huang WT, Guo HR, Chen YH, Chuang CH, Chang PC, Hung HK, Chen SH. Topical Antibiotic Prophylaxis for Preventing Surgical Site Infections of Clean Wounds: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2024; 25:32-38. [PMID: 38112687 DOI: 10.1089/sur.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Background: Topical antibiotic agents are not generally indicated for preventing of surgical site infections (SSIs) in clean incisions, and the drug concentrations that should be delivered to local incision sites remain uncertain. The aim of this study was to critically assess the efficacy of topical antibiotic agents in comparison with non-antibiotic agents for preventing SSIs in clean incisions by performing a systematic review and meta-analysis. Methods: We conducted a search of literature in PubMed, Embase, and Cochrane Databases and included randomized controlled trials (RCTs) on topical antibiotic use for patients with clean post-surgical incisions. The primary outcome was the incidence of SSI, presented as the event rate. Eleven RCTs were included. Results: Using random-effects modeling, the pooled risk ratio (RR) of developing a post-surgical incisions infection was 0.83 (95% confidence interval [CI], 0.61-1.16; I2, 0%). In subgroup analyses, no reductions in SSI were observed when topical antibiotic agents were used to treat incisions due to spinal (RR, 0.75; 95% CI, 0.40-1.38; I2, 0%), orthopedic (RR, 0.69; 95% CI, 0.37-1.29; I2, 0%), dermatologic (RR, 0.77; 95% CI, 0.39-1.55; I2, 65%), or cardiothoracic surgeries (RR, 1.31; 95% CI, 0.83-2.06; I2: 0%). The incidence of SSI across different operative phases did not differ for the application of topical antibiotic agents compared with non-antibiotic agents (RR, 0.80; 95% CI, 0.56-1.14; I2, 0%). Conclusions: The results of this meta-analysis show that topical antibiotic agents provide no clinical benefit for preventing SSI in clean incisions.
Collapse
Affiliation(s)
- Wen-Li Lin
- Center for Quality Management, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Thi-Hoang-Yen Nguyen
- Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Hsiu Lin
- Infection Control Center, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Chia-Jung Chen
- Center for Quality Management, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Wen-Tsung Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Hung Chen
- Pharmacy Department, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Chu-Hsin Chuang
- Division of General Surgery, Department of Surgery, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Ping-Chin Chang
- Department of Infectious Diseases, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Hui-Kun Hung
- Division of Plastic Surgery, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Shang-Hung Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
5
|
Zhang M, Feng H, Gao Y, Gao X, Ji Z. Effect of topical antibiotics on the prevention and management of wound infections: A meta-analysis. Int Wound J 2023; 20:4015-4022. [PMID: 37429583 PMCID: PMC10681525 DOI: 10.1111/iwj.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023] Open
Abstract
A meta-analysis research was implemented to appraise the effect of topical antibiotics (TAs) on the prevention and management of wound infections (WIs). Inclusive literature research was performed until April 2023, and 765 interconnected researches were reviewed. The 11 selected researches included 6500 persons with uncomplicated wounds at the starting point of the research: 2724 of them were utilising TAs, 3318 were utilising placebo and 458 were utilising antiseptics. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of TAs on the prevention and management of WIs by the dichotomous approach and a fixed or random model. TAs had significantly lower WI compared with placebo (OR, 0.59; 95% CI, 0.38-0.92, p = 0.02) and compared with antiseptics (OR, 0.52; 95% CI, 0.31-0.88, p = 0.01) in persons with uncomplicated wounds (UWs). TAs had significantly lower WIs compared with placebo and antiseptics in persons with UWs. However, caution needs to be taken when interacting with their values because of the low sample size of some of the chosen researches and low number of researches found for the comparisons in the meta-analysis.
Collapse
Affiliation(s)
- Meixue Zhang
- College of Traditional Chinese MedicineWeifang Medical UniversityWeifangChina
| | - Haonan Feng
- College of Traditional Chinese MedicineWeifang Medical UniversityWeifangChina
| | - Yongtao Gao
- Urology Department IWeifang Hospital of traditional Chinese MedicineWeifangChina
| | - Xiang Gao
- Department of Critical Care MedicineWeifang People's HospitalWeifangChina
| | - Zhixin Ji
- Department of Critical Care MedicineWeifang People's HospitalWeifangChina
| |
Collapse
|
6
|
Turkiewicz M, Shah A, Yang YW, Mangold A, Shen J. Allergic contact dermatitis of the eyelids: An interdisciplinary review. Ocul Surf 2023; 28:124-130. [PMID: 36898500 DOI: 10.1016/j.jtos.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE A review of the published literature on the pathogenesis and treatment of eyelid allergic contact dermatitis and ocular surface involvement. METHODS Literature search of MEDLINE (Ovid) was conducted using for allergic contact dermatitis and disease of the eyelid or periorbital skin. Dates included in search criteria were from January 1, 2010 to January 12, 2023. 120 articles were reviewed by at least two authors. RESULTS Allergic eyelid contact dermatitis(ACD) is a Type IV hypersensitivity reaction to chemical exposure of sensitized eyelid skin. Most patients improve with avoidance strategies. Understanding chemicals that may trigger eyelid ACD, identifying allergens with patch testing, and use of topical steroids can help patients with this challenging disease. CONCLUSIONS Recalcitrant allergic eyelid dermatitis can be addressed by an interdisciplinary team and avoidance strategies based on patch testing.
Collapse
Affiliation(s)
- Michal Turkiewicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Ami Shah
- Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Yul W Yang
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Aaron Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Joanne Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA.
| |
Collapse
|
7
|
Wang D, Shinder R. Comparison of Postoperative Infection Rates After Office-based Oculoplastic Procedures Using Sterile and Clean Gloves. Ophthalmic Plast Reconstr Surg 2023; 39:146-149. [PMID: 36095843 DOI: 10.1097/iop.0000000000002266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare postoperative infection (PI) rates using sterile and clean-boxed gloves in office-based oculoplastic procedures. METHODS Prospective, comparative study of patients undergoing oculoplastic procedures by a single surgeon (RS) in an office-based procedure room between October 2018 and September 2020. Participants included were 18 years or older. Excluded were patients on oral antibiotics within 2 weeks before the procedure, had a follow-up period of less than 1 week, had a contaminated wound, had complex reconstructions, or had multiple simultaneous procedures performed. Oculoplastic procedures were performed using either sterile or clean-boxed gloves. The main outcome measure was the frequency of postoperative infection. RESULTS Three thousand one hundred twenty-nine patients, 1,815 (58%) of whom were women, with a mean age of 60 (18-102) years were included. One thousand five hundred seventy procedures were performed with sterile gloves, while 1,559 were performed with clean-boxed gloves. The patients in the 2 groups were similar in age, gender, and number of high-risk individuals. One patient in the sterile glove group who underwent upper blepharoplasty (0.064%) and one patient (0.064%) in the clean-boxed glove group who had an external levator advancement blepharoptosis repair developed PI. Neither patient had risk factors for infection, and both infections resolved after 1 week of oral amoxicillin-clavulanate 875/125 mg twice daily. CONCLUSIONS In minimally complex in-office oculoplastic procedures, using sterile versus clean-boxed gloves resulted in similar low infection rates in this large cohort. The healthcare benefits may not outweigh the costs of using sterile gloves universally for office-based oculoplastic procedures.
Collapse
Affiliation(s)
- Diane Wang
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| |
Collapse
|
8
|
Doucet V, McKenzie M, Lee-Wing M, Bellan L. Infection rate following elective oculoplastic surgery in a minor procedure setting: a single-centre retrospective study. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:34-38. [PMID: 34358499 DOI: 10.1016/j.jcjo.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/05/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A surgical site infection after oculoplastic surgery is a serious complication that can lead to endophthalmitis and vision loss. Although performing these procedures in a minor-surgery setting is common, there is a lack of evidence in the literature regarding the incidence of postoperative infections. The objective of this study was to determine the infection rate associated with elective outpatient oculoplastic procedures performed in a minor-surgery setting. METHODS A retrospective review was completed for all patients who underwent elective oculoplastic surgery in the minor-procedure room at the Misericordia Health Centre in Winnipeg between April and December 2018. Operations were performed by 2 senior oculoplastic surgeons. Data collected included the type of procedure, number of surgical incisions, type and number of sutures, use of prophylactic antibiotics, time to follow-up, complications, and presence of surgical site infection. RESULTS Review of 539 patients showed an infection rate of 0.37% (2 of 539). Infection cases were an exposed orbital implant using a temporalis fascia graft and ptosis repair using a frontalis sling. Thirteen complications were identified, corresponding to a complication rate of 2.41% (13 of 539). CONCLUSION Study results show an infection rate of 0.37% for elective oculoplastic surgery in a minor-procedure setting.
Collapse
Affiliation(s)
- Véronique Doucet
- From the Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Section of Plastic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.
| | - Marna McKenzie
- From the Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Matthew Lee-Wing
- From the Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Lorne Bellan
- From the Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| |
Collapse
|
9
|
Liou V, Yoon M. Comparative Incidence of Periocular Surgical Site Infections with Increased Surgical Mask Use during the COVID-19 Pandemic. Ocul Immunol Inflamm 2022; 30:1913-1918. [PMID: 34524950 DOI: 10.1080/09273948.2021.1974491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the effect of surgical mask use on infection rates for office-based periocular surgeries during the pandemic. METHODS An Institutional Review Board-approved retrospective review of medical records identified patients who had an office-based oculofacial plastic surgery procedure during the pandemic between March and December 2020. Statistical analysis was used to compare this group to patients that underwent procedures between March and December 2019, prior to the pandemic when neither surgeon nor patient wore a surgical mask. RESULTS The study consisted of 680 patients. Thirty-one different types of procedures were encountered. The incidence of infections in 2020 compared to 2019 was not statistically significant (1.12% (n = 3) versus 1.21% (n = 5), p = 1). All patients with infections were treated with oral antibiotics and improved without long-term complications. CONCLUSIONS Periocular surgical site infections are uncommon, and the wearing of surgical masks by patient and surgeon during our office-based oculofacial procedures did not change the incidence of SSIs.
Collapse
Affiliation(s)
- Victor Liou
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Yoon
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Ashraf DC, Miller A, Ahmad M, Smith LD, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Augmentation of telemedicine post-operative follow-up after oculofacial plastic surgery with a self-guided patient tool. Orbit 2022:1-11. [PMID: 35920583 DOI: 10.1080/01676830.2022.2104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE This study evaluates a web-based tool designed to augment telemedicine post-operative visits after periocular surgery. METHODS Adult, English-speaking patients undergoing periocular surgery with telemedicine follow-up were studied prospectively in this interventional case series. Participants submitted visual acuity measurements and photographs via a web-based tool prior to routine telemedicine post-operative visits. An after-visit survey assessed patient perceptions. Surgeons rated photographs and live video for quality and blurriness; external raters also evaluated photographs. Images were analyzed for facial centration, resolution, and algorithmically detected blur. Complications were recorded and graded for severity and relation to telemedicine. RESULTS Seventy-nine patients were recruited. Surgeons requested an in-person assessment for six patients (7.6%) due to inadequate evaluation by telemedicine. Surgeons rated patient-provided photographs to be of higher quality than live video at the time of the post-operative visit (p < 0.001). Image blur and resolution had moderate and weak correlation with photograph quality, respectively. A photograph blur detection algorithm demonstrated sensitivity of 85.5% and specificity of 75.1%. One patient experienced a wound dehiscence with a possible relationship to inadequate evaluation during telemedicine follow-up. Patients rated the telemedicine experience and their comfort with the structure of the visit highly. CONCLUSIONS Augmented telemedicine follow-up after oculofacial plastic surgery is associated with high patient satisfaction, rare conversion to clinic evaluation, and few related post-operative complications. Automated detection of image resolution and blur may play a role in screening photographs for subsequent iterations of the web-based tool.
Collapse
Affiliation(s)
- Davin C Ashraf
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Amanda Miller
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Meleha Ahmad
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Loreley D Smith
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Ophthalmology Section, Surgical Service, San Francisco Veterans' Affairs Health Care System, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, California, USA
| |
Collapse
|
11
|
Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Reza Vagefi M. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens 2022; 48:162-168. [PMID: 35296627 PMCID: PMC8931268 DOI: 10.1097/icl.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum. METHODS A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed. RESULTS A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success. CONCLUSION Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.
Collapse
Affiliation(s)
- Amer F. Alsoudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Alan W. Kong
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Linyan Wang
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| |
Collapse
|
12
|
Chen PJ, Hua YM, Toh HS, Lee MC. Topical antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: a systematic review and meta-analysis. BJS Open 2022; 5:6509477. [PMID: 35038328 PMCID: PMC8763364 DOI: 10.1093/bjsopen/zrab125] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
Background Topical antibiotics are widely prescribed as prophylaxis for surgical site infection (SSI). Despite giving high drug concentrations at local wound sites, their efficacy remains controversial. This study is a systematic review and meta-analysis designed to compare the efficacy and safety of topical antibiotics with non-antibiotic agents in preventing SSI. Methods Randomized controlled trials (RCTs) comparing topical antibiotics in patients with clean and clean-contaminated postsurgical wounds were included. Relevant trials published before 30 September 2020, were searched in the PubMed, Embase, and Cochrane databases, without language restrictions. The primary outcome was the incidence of SSIs, presented as the event rate. The secondary outcome was the incidence of contact dermatitis (safety outcome). Data were synthesized using the random-effects model, with the results expressed as risk ratio (RR) with 95 per cent confidence intervals (c.i.). Results Thirteen RCTs were included. The incidence of SSIs and contact dermatitis showed no significant difference between topical antibiotics and non-antibiotic agents (RR 0.89, 95 per cent c.i. 0.59 to 1.32 (P = 0.56, I2 = 48 per cent); and RR 2.79, 95 per cent c.i. 0.51 to 15.19 (P = 0.24, I2 = 0 per cent), respectively). In the subgroup analyses, a reduction in SSIs was also not observed in dermatological (RR 0.77, 95 per cent c.i. 0.39 to 1.55; P = 0.46, I2 = 65 per cent), ocular (RR 0.08, 95 per cent c.i. 0.00 to 1.52; P = 0.09), spinal (RR 1.34, 95 per cent c.i. 0.65 to 2.77; P = 0.43, I2 = 0 per cent), orthopaedic (RR 0.69, 95 per cent c.i. 0.37 to 1.29; P = 0.25, I2 = 0 per cent), or cardiothoracic surgeries (RR 1.60, 95 per cent c.i. 0.79 to 3.25; P = 0.19). Conclusion Given the current evidence, the routine application of topical antibiotics to surgical wounds did not reduce the incidence of SSI. Further trials are needed to assess their effectiveness in high-risk surgeries or in selected patient groups.
Collapse
Affiliation(s)
- Po-Jung Chen
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Ming Hua
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
13
|
Kadaba VR, Ahluwalia H. Postoperative systemic antibiotic usage in elective eyelid surgery: is it really necessary? Orbit 2021; 41:321-323. [PMID: 33736568 DOI: 10.1080/01676830.2021.1901294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Conclusions: Avoidance of systemic antibiotic prophylaxis for LTS and anterior ptosis repair procedures was not associated with increased SSI rates. Given that prescriptions of antibiotics carry the risk of side-effects and growing antimicrobial resistance, we feel that our study shows that its routine use in this setting is of no benefit.
Collapse
Affiliation(s)
- Varsha R Kadaba
- Department of Ophthalmology, University Hospital of Coventry & Warwickshire, Coventry, WM, USA
| | - Harpreet Ahluwalia
- Department of Ophthalmology, University Hospital of Coventry & Warwickshire, Coventry, WM, USA.,Ophthalmology, Aston Medical School, Aston Medical School, Birmingham, UK
| |
Collapse
|
14
|
Antibiotic Ointment after Oculofacial Plastic Surgery: Does It Make a Difference? Ophthalmology 2020; 127:1755-1756. [PMID: 33222779 DOI: 10.1016/j.ophtha.2020.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
|