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Agarwal A, Joseph J, Naik MN. Delayed infections following polybutylate-coated polyester (Ethibond) suture frontalis suspension surgery for severe blepharoptosis. Orbit 2024:1-7. [PMID: 38687955 DOI: 10.1080/01676830.2024.2338789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To describe the incidence and management of delayed infections following frontalis sling suspension with polybutylate-coated polyester suture (Ethibond). METHODS Retrospective, interventional case series of 177 eyes of 150 patients, who underwent frontalis suspension surgery with Ethibond (Johnson and Johnson, USA), at L V Prasad Eye Institute, Hyderabad, India, between January 2016 and February 2022. Patients were assessed for chronic secondary sling infection, defined as infection/suture granuloma occurring beyond 6 weeks post-surgery. All patients received postoperative oral antibiotics. The clinical profile, microbiological evaluation, antibiotic sensitivity patterns, and management outcomes were analyzed. RESULTS Delayed infection following Ethibond sling suspension was noted in 14 eyes of 13 patients (7.9%). Of these, eight cases (61.5%) were females. The average time interval from surgery to presentation was 7.5 months (range: 2.5 months to 2.5 years). Eleven eyes underwent sling removal. Of the three who received initial antibiotic course, two eventually needed sling removal. Microbiological evaluation was available in seven eyes (50%), with Staphylococcus aureus as the most common organism. Of the six positive cultures, five (83.3%) were resistant to fluoroquinolones (FQs). CONCLUSION Frontalis suspension with Ethibond has an 8% incidence of delayed infections, with Staphylococcus aureus as the most common organism. The authors recommend early sling removal in all patients with infection and recommend consideration of an alternative material in the event of future revision surgery.
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Affiliation(s)
- Ayushi Agarwal
- Hariram Motumal Nasta & Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L.V. Prasad Eye Institute, Hyderabad, India
| | - Milind N Naik
- Hariram Motumal Nasta & Renu Hariram Nasta Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, India
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Gibbons AB, Niknahad A, Bacorn C, Li E. Microbiology and Antibiotic Resistance Profiles of Orbital Subperiosteal Abscesses: A Comparison of Pediatric, Adolescent, and Adult Populations. Ophthalmic Plast Reconstr Surg 2023; 39:583-587. [PMID: 37195825 DOI: 10.1097/iop.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE The purpose of this study was to compare the microbiology and antibiotic resistance profiles of orbital subperiosteal abscesses (SPA) among 3 age cohorts. METHODS A retrospective study was conducted at a tertiary care center through a medical record search to identify patients with orbital cellulitis and SPA on imaging from January 1, 2000 to September 10, 2022. Patients were categorized into pediatric (<9 years old), adolescent (9-18 years old), and adult (>18 years old) cohorts. Primary outcomes included culture and antibiotic susceptibility results. Secondary outcomes included antibiotic therapy and surgical intervention. RESULTS Of the 153 SPA patients included, 62 (40.5%) were in the pediatric cohort (4 months-8 years, mean 5.0 ± 2.7), 51 (33.3%) were adolescent (9-18 years, 12.7 ± 2.8), and 40 (26.1%) were adult (19-95, 51.8 ± 19.3). Viridians group Streptococci were the most frequent organisms isolated across groups. The anaerobic infection rate was higher in the adult compared to the pediatric group (23.0% vs, 4.0%, p = 0.017), while that of the adolescent did not differ significantly from either. Pediatric patients carried a lower rate of clindamycin resistance than adolescent and adult cohorts, who shared similar rates (0 vs. 27.0% and 28.0%, respectively; p = 0.016). There were progressive increases in duration of intravenous antibiotic therapy ( p < 0.195) and rate of surgical intervention ( p < 0.001) going from younger to older cohorts. CONCLUSION Organisms isolated from orbital SPA from the past 2 decades demonstrate a predominance of Streptococcal species. Older age may be associated with anaerobic infection, clindamycin resistance, and more aggressive management. Adolescent infections are more similar to adult rather than pediatric counterparts but may require less aggressive management than the former.
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Simmons BA, Kupcha AC, Law JJ, Wang K, Carter KD, Mawn LA, Shriver EM. Misdiagnosis of fungal infections of the orbit. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:449-454. [PMID: 35525264 DOI: 10.1016/j.jcjo.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the accuracy of the initial diagnosis in the case of fungal infections of the orbit and identify factors that may influence patient outcomes. METHODS An institutional review board-approved retrospective chart review was conducted across 2 large academic centres to identify cases of fungal infections involving the orbit from January 1, 1998, to November 15, 2019. Data collected included patient demographics, past medical history, examination findings, diagnosis, treatment, imaging, and outcomes. RESULTS Fifty cases of fungal infection involving the orbit were identified. Of these, 33 (66.0%) were initially misdiagnosed as nonfungal diagnoses. Sixteen patients (32.0%) received multiple initial diagnoses. The most common diagnoses on presentation were bacterial cellulitis (n = 12 of 50; 24.0%) and bacterial sinusitis (n = 12 of 50; 24.0%). These were followed by vascular and orbital inflammatory conditions (n = 9 of 50; 18.0%): 5 patients (10.0%) were clinically diagnosed with giant cell arteritis, 3 (6.0%) with nonspecific orbital inflammation, and 1 (2.0%) with optic neuritis. In this subset of patients, 77.8% (n = 7 of 9) were treated initially with systemic steroids. Additional initial diagnoses included neoplastic mass lesions, mucocele, dacryocystitis, cavernous sinus thrombosis, hemorrhage, tick-borne illness, allergic rhinitis, and allergic conjunctivitis. Misdiagnosis was significantly correlated with involvement of the masticator space on imaging (p = 0.04). CONCLUSION Fungal infections of the orbit are misdiagnosed in 2 of 3 cases. Nearly 15% of patients who are later diagnosed with fungal disease of the orbit were initially treated with systemic steroids. Misdiagnosis is more frequent when the masticator space is involved.
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Affiliation(s)
- Brittany A Simmons
- From the Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Anna C Kupcha
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tenn
| | - James J Law
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Keith D Carter
- From the Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Louise A Mawn
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Erin M Shriver
- From the Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
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Das AV, Joseph J. The microbiological landscape and epidemiology of ocular infections in a multi-tier ophthalmology network in India: an electronic medical record driven analytics report. Eye (Lond) 2023; 37:1590-1595. [PMID: 35907944 PMCID: PMC10219986 DOI: 10.1038/s41433-022-02191-3] [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: 01/29/2022] [Revised: 06/29/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To study the epidemiology and landscape of ocular infections in patients undergoing microbiological investigations across a multi-tier ophthalmology network in India. METHODS This cross-sectional hospital-based study included 15,822 patients in whom microbiology samples were analysed between September 2013 and December 2021. Ocular tissue of patients in whom a microbiology sample was processed in at least one eye were included. The data were collected using an indigenously developed electronic medical record system. RESULTS Among the 15,822 patients, bacteria (51.06%) was the most common aetiology followed by fungus (38.27%). The majority of the patients were male (68.10%) and adults (90.01%). The most common age group was during the sixth decade of life with 2,914 (18.42%) patients. The patients were more commonly from the lower socio-economic status (51.61%) and from the rural geography (46.82%). Majority of the specimens sent for microbiological analysis were corneal scrapings (68.61%) followed by vitreous (8.77%). The most common bacteria isolated was Staphylococcus aureus (14.45%) followed by Pseudomonas aeruginosa (12.53%) and among the fungus were Fusarium (30.53%) and Aspergillus species (29.86%). Acanthamoeba (1.26%) and Microsporidia (0.38%) accounted for a minority of the infections in the samples. Fungus (53.10%; p ≤ 0.00001) and virus (51.08%; p = 0.000673) aetiology was found to be significantly higher in patients presenting from the rural geography. CONCLUSION The most common aetiology of infection in ocular disease is bacterial but fungal infections also accounted for a significant proportion. The majority of the patients with ocular infections presented from the rural geography and from lower socio-economic status.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research Centre, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- The Ramoji Foundation for Ocular Infections, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Ang T, Tong JY, Selva D. Microbiology of bacterial orbital cellulitis-tertiary institutional experiences in South Australia: a multi-centre retrospective study. Int Ophthalmol 2023:10.1007/s10792-022-02624-8. [PMID: 36598712 DOI: 10.1007/s10792-022-02624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE This study describes the microbiology of bacterial orbital cellulitis (OC) over an 11-year period and its clinical associations at three tertiary institutions in Adelaide, South Australia. METHODS Multi-centre retrospective study of the microbiology of bacterial OC between January 2012 and August 2022. Pre-septal cellulitis was excluded. Differences in means were determined by the Independent Samples t-test, and categorical data was analysed via Pearson's Chi square. A P-value < 0.05 was statistically significant. RESULTS 99 patients (male: 69, mean age: 22.0 ± 23.8 years old), of which 70.7% were aged ≤ 18 years. Sinus and orbital abscess cultures had the greatest positive yield (73.7%). Frequency of organisms: Streptococcus species (34.3%), Staphylococcus aureus (28.3%), Haemophilus species (5.1%), mixed anaerobes (3.0%), Enterobacter cloacae (2.0%), Moraxella catarrhalis (1.0%), Pseudomonas aeruginosa (1.0%), Corynebacterium species (1.0%), Klebsiella pneumoniae (1.0%), Proteus mirabilis (1.0%), Citrobacter koseri (1.0%), and Enterococcus species (1.0%). Streptococcus species predominated in the paediatric population, with a statistically significant difference in mean age between Streptococcus species and Staphylococcus aureus (14.1 ± 16.5 vs 27.6 ± 24.6 years old, respectively) (P = 0.028). No organism was cultured in 32.3% of cases. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 28.6% of all Staphylococcus aureus isolates, with 50% occurring between 2021 and 2022. CONCLUSION Yearly microbiological trends have remained largely constant in South Australia. The causative organism was not identified in 32.3% of cases, further emphasising appropriate empirical antibiotics, and obtaining microbiology from various sources. MRSA OC remains of increased clinical and public health concern and may be associated with a more aggressive disease course.
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Affiliation(s)
- Terence Ang
- The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
| | - Jessica Y Tong
- The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.,Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dinesh Selva
- The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.,Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
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Das AV, Joseph J. The landscape of bacterial antibiotic susceptibility in a multi-tier ophthalmology network in India: an electronic medical record driven analytics report. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction. Injudicious use of antibiotics often leads to antibiotic resistance which contributes to significant morbidity and mortality. Knowledge of local antibiogram is important in informing appropriate empiric antimicrobial therapy.
Hypothesis / Gap. It is the first and largest study that examines bacterial isolates from multiple ocular infections across South India and provides a overview of susceptibility patterns for each individual bacteria in the detailed interactive dashboard.
Aim. To study the landscape of bacterial antibiotic susceptibility patterns of ocular infections in patients undergoing microbiological investigations across a multi-tier ophthalmology network in India.
Methodology. This cross-sectional hospital-based study included 15 822 patients in whom microbiology samples were analysed between September 2013 and December 2021. Ocular tissue of patients in whom a microbiology sample was processed in at least one eye were included as cases. The data were collected using an indigenously developed electronic medical record (EMR) system.
Results. Among the 15 822 patients, bacteria (51.06 %) was the most common aetiology, followed by fungus (38.27 %). The majority of the patients were male (68.10 %) and the majority were adults (90.01 %). The most common age group was during the sixth decade with 2914 (18.42 %) patients. The patients were more commonly from the lower socio-economic status (51.61 %) and rural geography (46.82 %). The majority of the specimens sent for microbiological analysis were corneal scraping (68.61 %). Gram-positive cocci and Gram-positive bacilli were most sensitive towards vancomycin (86.83 and 92.89% respectively) followed by cefazolin (80.88 %) and amikacin, while Gram-negative bacilli were most sensitive towards ofloxacin (65.24%).
Conclusion. The most common aetiology of infection in ocular disease is bacterial and the majority of the patients presented from the rural geography and from lower socio-economic status. While vancomycin continues to be the drug of choice for Gram-positive organisms, increasing resistance to fluoroquinolones and ceftazidime was observed. Adoption of this model will enable access to antimicrobial susceptibility data, leading to reliable decisions and better clinical outcomes.
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Affiliation(s)
- Anthony Vipin Das
- Indian Health Outcomes, Public Health, and Economics Research Centre, Hyderabad, Telangana, India
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- The Ramoji Foundation Centre for Ocular Infections, Hyderabad
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