Ocular flora and their antibiotic susceptibility in patients having cataract surgery in Italy

• Published in: Journal of cataract and refractive surgery Vol. 42; no. 9; pp. 1312 - 1317
• Main Authors: Papa, Vincenzo, MD, PhD, Blanco, Anna Rita, BSc, Santocono, Marcello, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Anti-Bacterial Agents - pharmacology; Bacteria - isolation & purification; Cataract; Cataract Extraction; Conjunctiva - microbiology; Drug Resistance, Bacterial; Eyelids - microbiology; Humans; Italy; Microbial Sensitivity Tests; Ophthalmology
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2016.07.022

Purpose To characterize the ocular flora in a consecutive group of patients having cataract surgery and to determine the antibiotic susceptibility profile of isolates to several ophthalmic antibiotics. Setting Hospital Di Stefano, Catania, Italy. Design Observational case series. Methods Conjunctival and eyelid cultures from patients were obtained 14 days before surgery and, if positive, repeated the day of the surgery. Antimicrobial susceptibility for aminoglycosides (netilmicin and tobramycin), fluoroquinolones (ofloxacin, levofloxacin, and moxifloxacin), chloramphenicol, and azithromycin was tested using the Kirby-Bauer disk diffusion method. Susceptibility was also tested for oxacillin, cefuroxime, and vancomycin. All positive patients received a 2-day preoperative course of 3 mg/mL netilmicin ophthalmic solution 4 times a day. The recovery rate of microorganisms after antibiotic treatment compared with baseline was calculated. Results One hundred twenty consecutive patients were included in the study. Cultures were positive in 72.5% of patients; 131 isolates, mainly gram-positive, were identified. Staphylococcus epidermidis (58.0%) and Staphylococcus aureus (15.3%) were the most frequently isolated microorganisms. Methicillin-resistant staphylococci accounted for 3.8% of S epidermidis and 20.0% of S aureus . A high in vitro susceptibility (>90%) for all isolates, including multiresistant coagulase-negative Staphylococcus, was obtained for netilmicin, vancomycin, and cefuroxime. The recovery rate of isolates before surgery was reduced by 93.9% ( P  < .001). Conclusions Conjunctival and lid margin isolates were sensitive to netilmicin, vancomycin, and cefuroxime. Microorganisms were less susceptible to other ophthalmic antibiotics, with the exception of moxifloxacin. A 2-day preoperative course with topical netilmicin reduced most bacteria identified on the conjunctiva and eyelids. Financial Disclosure Dr. Papa and Ms. Blanco are employees of Società Industria Farmaceutica Italiana SpA. Dr. Santocono has no financial or proprietary interest in any material or method mentioned.