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      Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

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          Abstract

          Background

          Endophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair.

          Results

          Institutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair.

          Conclusions

          Despite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

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          Post-traumatic Infectious Endophthalmitis.

          Neelakshi Bhagat, Saya Nagori, Marco Zarbin (2011)
          Post-traumatic endophthalmitis is an uncommon yet devastating complication of an open globe injury. Risk factors include presence of an intraocular foreign body (IOFB), lens rupture, delayed primary globe repair, rural trauma, and trauma with contaminated objects. Visual prognosis in post-traumatic endophthalmitis is affected by the virulence of the microbe, the presence of a retinal break or detachment, the timing of treatment, the presence or absence of an IOFB, and the extent of initial injury. Treatment should be started emergently with systemic and intravitreal antibiotics. In the setting of penetrating ocular trauma, antibiotic prophylaxis of endophthalmitis should be considered. The best treatment regimen has not been determined. The most frequent prophylactic regimens are: treatment with oral antibiotics, a short course of intravenous antibiotics followed by oral antibiotics, or intravitreal antibiotics plus oral antibiotics. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Endophthalmitis following open-globe injuries.

            Harry Flynn, Gasmelseed Ahmed, A Schimel … (2012)
            The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.
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              Low rate of endophthalmitis in a large series of open globe injuries.

              DEMETRIOS VAVVAS, Michael T Andreoli, Gittte C. Kloek … (2009)
              To determine the percentage of patients in whom endophthalmitis developed after open globe injury. Retrospective, noncomparative, consecutive case series. Charts of all patients (675 in total) treated surgically for open globe injury at the Massachusetts Eye and Ear Infirmary (MEEI) between January 1, 2000 and July 31, 2007 were reviewed. Cases with at least 30 days of follow-up were included in statistical analyses (558 in total). A standardized treatment protocol was used in all cases. Intravenous vancomycin and ceftazidime were started on admission and were stopped after 48 hours. Patients were discharged on topical antibiotics, corticosteroids, and cycloplegia. Surgical repairs were performed by the chief of trauma, a full-time position rotating yearly, who is on call for all open globe trauma. Data collection variables included timing of injury and repair, mechanism of injury, details of surgical repair, and details of follow-up such as duration, presence of complications, and vision. A primary outcome measure of endophthalmitis and secondary outcome measure of risk factors for endophthalmitis were studied. During 7.5 years, 675 open globe injuries were treated at MEEI. Of these, 558 had at least 30 days of follow-up (mean, 11 months) and were used in statistical analyses. The overall percentage of endophthalmitis was 0.9% (3 culture-positive cases and 2 culture-negative cases). Four of the 5 cases achieved final acuity of 20/80 or better. Risk factors for endophthalmitis included intraocular foreign body (P = .03; odds ratio, 7.52) and primary intraocular lens placement (P = .05). A standardized protocol including surgical repair by a dedicated eye trauma service and 48 hours of intravenous antibiotics was associated with a posttraumatic endophthalmitis percentage of less than 1%.
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                Author and article information

                Contributors
                Ryan T. Drumright: rdrumright@mmclinic.com
                Kathleen A. Regan: kregan3@wisc.edu
                Albert L. Lin: alin@umc.edu
                Meghan G. Moroux: meghan.g.moroux@medstar.net
                Siva S. R. Iyer:
                ORCID: http://orcid.org/0000-0002-3442-2311
                ssr@ufl.edu
                Journal
                Journal ID (nlm-ta): J Ophthalmic Inflamm Infect
                Journal ID (iso-abbrev): J Ophthalmic Inflamm Infect
                Title: Journal of Ophthalmic Inflammation and Infection
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 1869-5760
                Publication date (Electronic): 3 February 2020
                Publication date PMC-release: 3 February 2020
                Publication date Collection: 2020
                Volume: 10
                Electronic Location Identifier: 5
                Affiliations
                [1 ]Murfreesboro Medical Clinic, 1272 Garrison Dr, Murfreesboro, TN 37129 USA
                [2 ]ISNI 0000 0001 2167 3675, GRID grid.14003.36, Department of Ophthalmology and Visual Sciences, , University of Wisconsin School of Medicine and Public Health, ; 2880 University Avenue, Madison, WI 53705 USA
                [3 ]ISNI 0000 0001 2169 2489, GRID grid.251313.7, Department of Ophthalmology, , University of Mississippi School of Medicine, ; 2500 N State Street, Jackson, MS 39216 USA
                [4 ]ISNI 0000 0001 1955 1644, GRID grid.213910.8, Department of Ophthalmology, , Georgetown University, ; Washington DC. 3800 Reservoir Road, Washington, DC 20007 USA
                [5 ]ISNI 0000 0004 1936 8091, GRID grid.15276.37, Department of Ophthalmology, , University of Florida College of Medicine, ; 1600 SW Archer Rd, Gainesville, FL 32610 USA
                Author information
                http://orcid.org/0000-0002-3442-2311
                Article
                Publisher ID: 196
                DOI: 10.1186/s12348-020-0196-5
                PMC ID: 6995799
                PubMed ID: 32009215
                SO-VID: d3cf4708-4c84-4ea3-ba9b-6ec27069d038
                Copyright © © The Author(s). 2020
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 21 November 2018
                Date accepted : 8 January 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;
                Categories
                Subject: Original Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: globe trauma,endophthalmitis,culture,open globe injury
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: globe trauma, endophthalmitis, culture, open globe injury

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