Risk of conjunctival colonization by cefuroxime-resistant bacteria in cataract surgery patients younger than 75 years and aged 75 or older

Abstract

Background and objective

Bacteria isolated in postoperative endophthalmitis (PE) were reduced to cefuroxime-resistant bacteria in cataract surgery with intracameral cefuroxime as prophylaxis; age > 84 years was at risk for PEs caused by Gram-negative-bacteria and Staphylococci; no risks were identified for Enterococci, the most abundant isolations. The prevalence of Enterococci in the preoperative conjunctiva was associated with age > 74 years, diabetes, obesity, and dacryocystorhinostomy-history (DCR-history). The aim of the study is to differentiate the risk of age from that of other patient characteristics, establishing 2 different age groups.

Materials and methods

We conducted a retrospective cross-sectional study in a tertiary referral center. In 7,085 patients < 75 years old and 7,798 ≥ 75 years, the incidence rate ratio (IRR) of Enterococci, Enterobacteriaceae, Non-fermentative-Gram-negative-bacilli (NFGNB) and Coagulase-negative-Staphylococci (CNS) was calculated for the following factors: diabetes, obesity, DCR-history, sex-male, smoking-habit, and climate, using multivariate Poisson regression, IBM SPSS Statistic for Windows, version 25.0. Armonk, NY: IBM Corp.

Results

Diabetes, obesity, male-sex and smoking-habit were more prevalent in patients < 75 years old. The IRRs of Enterococci, Enterobacteriaceae and NFGNB were higher in this age group: [Enterococci IRRs: diabetes, 1.54 vs 1.42; obesity, 2.95 vs 1.50; DCR-history, 3.78 vs 1.08]; [Enterobacteriaceae IRRs: diabetes, 1.47 vs 1.13; obesity, 2.27 vs 1.99; male-sex, 1.76 vs 1.65]; [NFGNB IRRs: diabetes, 1.79 vs 1.16; autumn-weather, 2.05 vs 1.56]. Diabetes-obesity simultaneously: Enterobacteriaceae IRR, 3.30 vs 2.28; Enterococci IRR, 3.28 vs 1.62.

Conclusions

Diabetes, obesity and DCR-history increase the IRR of Enterococci, Enterobacteriaceae and NFGNB in patients < 75 years more than they actually do in patients ≥ 75.

Resumen

Antecedentes y objetivo

Las bacterias aisladas en endoftalmitis postquirúrgica (EP) se redujeron a las cefuroxima-resistentes en cirugía de cataratas con cefuroxima intracameral como profilaxis; la edad >84 años fue riesgo para EPs causadas por bacterias-Gram-negativas y Staphylococci; no se identificaron riesgos para Enterococci, el aislamiento más abundante. La prevalencia de Enterococci en la conjuntiva preoperatoria se asoció con edad >74 años, diabetes, obesidad e historia de dacriocistorrinostomía (historia-DCR). El objetivo del estudio es diferenciar el riesgo de la edad del de otras características del paciente, estableciendo dos grupos de edad.

Materiales y métodos

Estudio transversal retrospectivo en hospital terciario. En 7.085 pacientes <75 años y 7.798 de ≥75, se calcula la Razón de Tasa de Incidencia (RTI) de Enterococci, Enterobacteriaceae, Bacilos-Gram-negativos-no-fermentadores (BGNNF), y Staphylococci-coagulasa-negativos (SCN), para los factores: diabetes, obesidad, historia-DCR, sexo-varón, hábito-tabáquico, y clima, mediante regresión de Poisson multivariante, programa IBM SPSS Statistic for Windows, versión 25.0. Armonk, NY: IBM Corp.

Resultados

Diabetes, obesidad, sexo-varón y hábito-tabáquico fueron más prevalentes en pacientes <75 años. Las RTIs de Enterococci, Enterobacteriaceae y BGNNF fueron mayores en esa edad: [RTI de Enterococci: diabetes 1,54 vs 1,42; obesidad 2,95 vs 1,50; historia-DCR 3,78 vs 1,08]; [RTI de Enterobacteriaceae: diabetes 1,47 vs 1,13; obesidad 2,27 vs 1,99; sexo-varón 1,76 vs 1,65]; [RTI de BGNNF: diabetes 1,79 vs 1,16; clima-otoñal 2,05 vs 1,56]. Diabetes-obesidad simultaneas: Enterobacteriaceae 3.30 vs 2.28; Enterococci 3,28 vs 1,62.

Conclusiones

Diabetes, obesidad e historia-DCR incrementan más la incidencia de Enterococci, Enterobacteriaceae y BGNNF en pacientes <75 años que en ≥75.