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. 2022 Jul 30;22(1):328.
doi: 10.1186/s12886-022-02544-2.

Conjunctival sac bacterial culture of patients using levofloxacin eye drops before cataract surgery: a real-world, retrospective study

Zhenyu Wang #  1   2 , Pei Zhang #  1   2 , Chen Huang #  1   2   3 , Yining Guo  1   2 , Xuhe Dong  1   2 , Xuemin Li  4   5
Affiliations

Conjunctival sac bacterial culture of patients using levofloxacin eye drops before cataract surgery: a real-world, retrospective study

Zhenyu Wang et al. BMC Ophthalmol. .

Abstract

Background: The use of antibiotics preoperatively is effective to decrease the incidence of ocular bacterial infections but may lead to high resistance rate, especially on patients with multi-risk clinical factors. This study systematically analyzed real-world data (RWD) of patients to reveal the association between clinical factors and conjunctival sac bacterial load and offer prophylaxis suggestions.

Methods: We retrieved RWD of patients using levofloxacin eye drops (5 mL: 24.4 mg, 4 times a day for 3 days) preoperatively. Retrieved data included information on the conjunctival sac bacterial culture, sex, presence of hypertension and diabetes mellitus (DM), and history of hospital-based surgeries. Data was analyzed using SPSS 24.0.

Results: RWD of 15,415 cases (patients) were retrieved. Among these patients, 5,866 (38.1%) were males and 9,549 (61.9%) females. 5,960 (38.7%) patients had a history of hypertension, and 3,493 (22.7%) patients had a history of DM. 7,555 (49.0%) patients had a history of hospital-based operations. There were 274 (1.8%) positive bacterial cultures. Male patients with hypertension and DM may be at increased risk of having positive bacterial cultures (P < 0.05). Staphylococcus epidermidis (n = 56, 20.4%), Kocuria rosea (n = 37, 13.5%), and Micrococcus luteus (n = 32, 11.7%) were the top 3 isolated strains. Most bacterial strains were resistant to various antibiotics except rifampin, and 82.5% (33 of 40 isolates) of Staphylococcus epidermidis isolates had multidrug antibiotic resistance. Numbers of culture-positive Staphylococcus epidermidis isolates in the male group and non-DM group were greater than those in the female and DM groups, respectively. Micrococcus luteus (n = 11, 8.8%) was found less frequently in non-hypertension group than in hypertension group.

Conclusion: Sex (Male) and the presence of hypertension and DM are risk factors for greater conjunctival sac bacterial loads. We offer a prophylactic suggestion based on the combined use of levofloxacin and rifampin. However, this approach may aggravate risk of multidrug resistance.

Keywords: Antibiotic prophylactic therapy; Clinical factor; Levofloxacin; Real world study.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A Number of culture-positive samples for the top 10 identified bacterial strains. B Pie graphs showing the percentage of postoperative endophthalmitis for the three most common isolates
Fig. 2
Fig. 2
Upsetview of multidrug resistance of Staphylococcus epidermidis
Fig. 3
Fig. 3
Violin plot of K-B test of Staphylococcus epidermidis against Rifampin. Each red line represents the median of each subgroup
See this image and copyright information in PMC

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