*Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; and †Eyesthetica, Oculofacial and Cosmetic Surgery Associates, Los Angeles, California, U.S.A.
Ophthalmic Plast Reconstr Surg. 2013 Sep-Oct;29(5):376-81. doi: 10.1097/IOP.0b013e31829a7313.
To investigate microbiologic trends and role of biofilm on periorbital biomaterials surgically explanted for recalcitrant infection.
A search of the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine microbiology laboratory electronic database was conducted from 1980 to 2010. Culture results were analyzed from submitted periorbital biomaterials explanted for nonresolving infections or exposure. Random select samples cultured during the study were sent for electron microscopy.
Twenty-one explanted biomaterials were identified from 18 patients. Five orbital plate implants included 2 made of nylon, 1 of porous polyethylene, 1 of silicone, and 1 metallic. Of 4 anophthalmic socket sphere implants, 2 were silicone, 1 was porous polyethylene, and 1 was poly-2-hydroxyethyl methacrylate. Lacrimal intubation devices included 10 silicone stents and 2 pyrex glass Jones tubes. All biomaterials were culture positive with 40 total isolates identified. The most common organisms overall were Mycobacterium chelonae (N = 9), Staphylococcus aureus (N = 8), and Pseudomonas aeruginosa (N = 3). One hundred percent of orbital spheres had Gram-positive organisms, 90% of lacrimal silicone stents grew atypical mycobacterium, and 60% of orbital plates were culture positive for yeast species. Mixed organism growth was documented on 58% of the specimens. Ten of 12 implants (83%) examined with electron microscopy exhibited organisms encased in glycocalyx, suggestive of biofilm.
A diverse array of microorganisms can colonize biomaterials implanted within the orbit and lacrimal drainage system. The authors' study showed that the majority of infected periocular and orbital alloplastic implants display biofilm when studied with electron microscopy (83%). The cultured organism type depended on the implant location and composition. Most infected silicone lacrimal stents grew atypical mycobacterium, whereas infected orbital fracture repair plates demonstrated yeast species. Biofilms are known to be antibiotic resistant, explaining the need to explant most infected alloplastic implants. Further research concerning treatment of biofilms may prevent explantation and improve surgical outcomes.
研究微生物趋势和生物膜在因难治性感染而被手术取出的眶周生物材料中的作用。
对迈阿密米勒医学院巴斯康帕尔默眼科研究所的微生物实验室电子数据库进行了 1980 年至 2010 年的搜索。分析了因非感染性或暴露性而未愈合的感染而被手术取出的眶周生物材料的培养结果。在研究期间随机选择的样本被送去进行电子显微镜检查。
从 18 名患者中确定了 21 个被取出的生物材料。5 个眶板植入物包括 2 个尼龙，1 个多孔聚乙烯，1 个硅胶和 1 个金属。4 个眼球摘除球植入物中，2 个为硅胶，1 个为多孔聚乙烯，1 个为聚 2-羟乙基甲基丙烯酸酯。泪管插管装置包括 10 个硅胶支架和 2 个 Pyrex 玻璃琼斯管。所有生物材料的培养结果均为阳性，共鉴定出 40 种分离株。总的来说，最常见的病原体是龟分枝杆菌（N=9），金黄色葡萄球菌（N=8）和铜绿假单胞菌（N=3）。100%的眶球有革兰氏阳性菌，90%的泪道硅胶支架生长非典型分枝杆菌，60%的眶板培养出酵母菌。58%的标本有混合菌生长。用电子显微镜检查的 12 个植入物中有 10 个（83%）显示出被糖萼包裹的生物体，提示存在生物膜。
各种各样的微生物可以定植于眼眶和泪液引流系统中植入的生物材料。作者的研究表明，当用电子显微镜检查时，大多数感染的眶周和眼眶异体植入物都显示出生物膜（83%）。培养出的生物体类型取决于植入物的位置和组成。大多数感染的硅胶泪道支架生长非典型分枝杆菌，而感染的眼眶骨折修复板显示出酵母菌。生物膜已知具有抗药性，这解释了为什么大多数感染的异体植入物都需要被取出。进一步研究生物膜的治疗方法可能会预防植入物的取出并改善手术结果。
