体外研究考察了抗菌预防措施对抗生素耐药性眼内炎的有效性。

In vitro study examining the effectiveness of antiseptic prophylaxis for antibiotic-resistant bacterial endophthalmitis.

机构信息

From the Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland (O'Rourke, Barry, Khan); Department of Microbiology, The National Maternity Hospital, Dublin, Ireland (Knowles, Curry, Kealy); European Society of Cataract and Refractive Surgeons, Dublin, Ireland (Barry, Khan).

出版信息

J Cataract Refract Surg. 2021 Dec 1;47(12):1581-1586. doi: 10.1097/j.jcrs.0000000000000599.

DOI:10.1097/j.jcrs.0000000000000599

PMID:34846336

Abstract

PURPOSE

To assess the effectiveness of current antiseptic agents on multidrug-resistant (MDR) isolates in an in vitro setting.

SETTING

Department of Microbiology, The National Maternity Hospital, Dublin, Ireland.

DESIGN

Organisms were selected based on current review of endophthalmitis literature: methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), Pseudomonas aeruginosa, carbapenem-resistant and extended-spectrum β-lactamase Klebsiella pneumoniae, and vancomycin-resistant (VRE) Enterococcus faecalis.

METHODS

Samples were exposed to povidone-iodine (PVI) 5% and chlorhexidine (CHX) 0.05% for 0.5 minutes, 1 minute, 3 minutes, and 5 minutes. After inactivation, organisms were incubated under standard conditions and growth assessed after 16 hours.

RESULTS

MRSA and MRSE responded to 3-minute PVI exposure. CHX eradicated MRSA growth after 5 minutes but failed to completely suppress MRSE. Pseudomonas and Klebsiella required 3-minute CHX exposure and 5-minute PVI exposure for complete clearance. Eradication of enterococci (VRE positive and negative) was not achieved at 10 minutes of CHX or PVI exposure. Comparison of PVI vs CHX showed a benefit for PVI in MRSA (P < .01) and MRSE (P < .001) eradication at 3 minutes.

CONCLUSIONS

Current recommendations of 3 minutes of antisepsis prior to intraocular surgery are not sufficient for complete eradication of MDR organisms from the ocular surface. A bespoke approach is suggested to patients at risk for carriage of MDR organisms to minimize the risk of endophthalmitis.

摘要

目的

评估在体外环境中当前抗菌剂对多重耐药（MDR）分离株的有效性。

地点

爱尔兰都柏林国家妇产医院微生物学系。

设计

根据当前眼内炎文献综述选择了以下生物体：耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林表皮葡萄球菌（MRSE）、铜绿假单胞菌、产碳青霉烯酶和扩展谱β-内酰胺酶肺炎克雷伯菌和万古霉素耐药（VRE）粪肠球菌。

方法

将样本暴露于聚维酮碘（PVI）5%和洗必泰（CHX）0.05%中 0.5 分钟、1 分钟、3 分钟和 5 分钟。灭活后，将生物体在标准条件下孵育，并在 16 小时后评估生长情况。

结果

MRSA 和 MRSE 对 3 分钟 PVI 暴露有反应。CHX 在 5 分钟后消灭了 MRSA 的生长，但未能完全抑制 MRSE。铜绿假单胞菌和肺炎克雷伯菌需要 3 分钟的 CHX 暴露和 5 分钟的 PVI 暴露才能完全清除。10 分钟的 CHX 或 PVI 暴露不能消灭肠球菌（VRE 阳性和阴性）。PVI 与 CHX 的比较表明，在 3 分钟时 PVI 在 MRSA（P <.01）和 MRSE（P <.001）的清除方面具有优势。