与桌面式高压灭菌器生物膜相关的弥漫性层状角膜炎：病例系列及综述。

Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review.

机构信息

From the Department of Ophthalmology (Sorenson), Alta Bates Summit Medical Center, and School of Optometry (Sorenson, Tran, Evans, Lin), University of California, Berkeley, California, USA; Department of Ophthalmology (Holland), University of British Columbia, British Columbia, Vancouver, Canada; College of Pharmacy (Evans), Touro University California, Vallejo, Vision Science Graduate Group (Lin), University of California, Berkeley, California, and Moran Eye Center (Mamalis), University of Utah Medical Center, Salt Lake City, Utah, and Altos Eye Physicians (Chang), Los Altos, California, USA.

出版信息

J Cataract Refract Surg. 2020 Mar;46(3):340-349. doi: 10.1097/j.jcrs.0000000000000070.

DOI:10.1097/j.jcrs.0000000000000070

PMID:32050209

Abstract

PURPOSE

To report a diffuse lamellar keratitis (DLK) cluster attributed to autoclave reservoir biofilm and to review the risk and prevention of DLK and toxic anterior segment syndrome (TASS) caused by such biofilms.

SETTING

Refractive Surgery Center, University of California, Berkeley.

DESIGN

Observational case-control study and review of literature.

METHODS

Eyes were evaluated for DLK following laser in situ keratomileusis (LASIK) over a 5-year period. Multiple changes in surgical and operating room protocols were prompted by a cluster of DLK cases. The autoclave reservoir chamber wall was cultured for microbial contamination. The MEDLINE database was used to identify relevant past publications.

RESULTS

From January 7, 2010, to December 18, 2014, 1115 eyes received LASIK. Between September 2, 2010, and June 11, 2012, 147 eyes of 395 LASIK cases developed DLK (37.2%). Systematic modifications in surgical protocols were unsuccessful in ending the prolonged cluster of DLK cases until the STATIM 2000 autoclave was replaced with a new STATIM autoclave and a reservoir sterilization and surveillance protocol implemented. Over the subsequent 30 months, DLK incidence was reduced to 2.2% (14 DLK cases from 632 total LASIK cases, P < .0001). The retired autoclave reservoir chamber wall cultures grew Pseudomonas aeruginosa and the Burkholderia cepacia complex.

CONCLUSIONS

Fluid reservoirs of tabletop steam autoclaves can readily develop polymicrobial biofilms harboring microbial pathogens, whose inert molecular byproducts can cause DLK and TASS when introduced to the eye by surgical instruments. Stringent reservoir cleaning and maintenance may significantly reduce this risk by preventing and removing these biofilms.

摘要

目的

报告一起由高压蒸汽灭菌器储水罐生物膜引起的弥漫性层状角膜炎（DLK）聚集事件，并回顾此类生物膜引起的 DLK 和前节毒性综合征（TASS）的风险和预防措施。

地点

加州大学伯克利分校屈光手术中心。

设计

观察性病例对照研究和文献复习。

方法

在 5 年期间，对接受激光原位角膜磨镶术（LASIK）后的眼睛进行 DLK 评估。一系列 DLK 病例促使手术和手术室方案发生了多次变化。对高压蒸汽灭菌器储水罐腔壁进行微生物污染培养。使用 MEDLINE 数据库确定相关的既往出版物。

结果

从 2010 年 1 月 7 日至 2014 年 12 月 18 日，1115 只眼睛接受了 LASIK。在 2010 年 9 月 2 日至 2012 年 6 月 11 日期间，395 例 LASIK 病例中的 147 只眼（37.2%）发生了 DLK。直到更换了新的 STATIM 高压蒸汽灭菌器，并实施了储水罐消毒和监测方案，系统性地修改手术方案才成功结束了持续的 DLK 病例聚集。在随后的 30 个月中，DLK 发病率降低至 2.2%（632 例 LASIK 中 14 例发生 DLK，P<0.0001）。退役的高压蒸汽灭菌器储水罐腔壁培养物中生长出铜绿假单胞菌和洋葱伯克霍尔德菌复合群。