Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 3706
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
ORIGINAL ARTICLE
Year : 1994  |  Volume : 42  |  Issue : 2  |  Page : 71-74

Donor corneoscleral rim contamination by gentamicin-resistant organisms


1 Sri Devchand Nagardas Jhaveri Microbiology Centre, Hyderabad, India
2 Sight Savers' Cornea Training Centre, L.V. Prasad Eye Institute, Hyderabad 500 034, India
3 Sri Devchand Nagardas Jhaveri Microbiology Centre,& Sight Savers Cornea Training Centre, L.V. Prasad Eye Institute, Hyderabad 500 034, India

Correspondence Address:
Savitri Sharma
L.V. Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad 500 034
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 7927634

Rights and PermissionsRights and Permissions
  Abstract 

Gentamicin is the most widely used antibiotic in the decontamination of donor cornea for penetrating keratoplasty. However, the incidence of resistance to gentamicin is on the rise. Bacterial isolates from 178 donor corneal rims were studied for gentamicin sensitivity. The overall rate of gentamicin resistance was 63.4%. At 86.2% the Pseudomonas. species had the highest rate of resistance, followed by Streptococci at 84.6%. The high rate of gentamicin resistance encountered by us and others suggest that either addition of a second antibiotic to corneal storage media or replacement of gentamicin by an antibiotic with a broader spectrum of activity may help reduce the risk of endophthalmitis following penetrating keratoplasty

Keywords: Gentamicin resistance - Donor cornea - Bacteria - Endophthalmitis - Penetrating keratoplasty


How to cite this article:
Gopinathan U, Agrawal V, Sharma S, Rao GN. Donor corneoscleral rim contamination by gentamicin-resistant organisms. Indian J Ophthalmol 1994;42:71-4

How to cite this URL:
Gopinathan U, Agrawal V, Sharma S, Rao GN. Donor corneoscleral rim contamination by gentamicin-resistant organisms. Indian J Ophthalmol [serial online] 1994 [cited 2019 Jul 20];42:71-4. Available from: http://www.ijo.in/text.asp?1994/42/2/71/25580



Click here to view


Click here to view


Click here to view


Click here to view


Click here to view


Click here to view
Despite the advances made in corneal preservation with the introduction of new media allowing enhanced duration of corneal storage, the ideal environmental conditions for corneal storage and sterilisation are not well defined.

Bacterial endophthalmitis remains a serious and often a devastating complication of penetrating keratoplasty. The reported incidence of bacterial endophthalmitis after penetrating keratoplasty is 0.8%, [1 ] compared to 0.09% incidence reported after extracapsular cataract extraction. [2] Gram-positive bacteria, particularly Staphylococcus and Streptococcus species are the most common causative organisms, while gram-negative organisms occur less frequently.

Gentamicin is the only antibiotic contained in all commercially available corneal storage media. [4] Previous studies have shown the broad-spectrum bactericidal activity of gentamicin. [5]. [6] In a study on cultures taken from 4,167 donor eyes, it was found that more than 90% of all bacterial isolates were sensitive to gentamicin alone. [7]

This study was conducted to ascertain whether the widespread use of gentamicin has in anyway altered the sensitivity pattern of the bacterial isolates and to assess the emerging trends in antibiotic resistance in media and moist chamber preserved corneas.


  Materials and methods Top


The corneoscleral rims included in this study were obtained from moist chamber preserved donor globes or corneal storage media (Optisol or McCarey­Kaufman). Prior to keratoplasty the rims from donor globes were soaked in 0.3% gentamicin solution for one hour. The storage media with rims were left at room temperature (23°C) before usage. Following the removal of corneal buttons for keratoplasty, the rims were sent immediately to the laboratory in a dry sterile bottle where they were processed according to a standard protocol. Briefly, the rim was cut into five pieces using aseptic techniques and each piece was placed in a different medium. The media used, the duration and atmospheric condition of incubation are shown in [Table - 1]. Growth in any one or more media was considered as positive.

The organisms recovered were identified employing standard microbiological methods and all bacterial isolates were subjected to tests for antibiotic susceptibility using Kirby-Bauer disc diffusion method. Disc containing 10 ug of gentamicin (Hi-media, Bombay) were used on a standard bacterial suspension lawn made on Mueller-Hinton agar. Following 18 hours incubation at 35°C, an inhibitory zone of 12 mm or less was recorded as resistance to gentamicin.


  Results Top


A total of 648 corneoscleral rims from donor corneal buttons were cultured from April 1991 to March 1993. Of the 648 rims, 311 (47.9%) were culture positive for microorganisms. The total number of isolates, however, were 414 as more than one organism was isolated from 72 (11.1%) rims.

Bacteria accounted for 242 (58.4%) of the 414 isolates and fungi were seen in 172 (41.5%) isolates. Among the bacteria, 72.3% were gram-positive and 27.7% were gram-negative. Coagulase-negative staphylococci at 127 (52.4%) isolates were the most common bacteria isolated. Next in frequency were Pseudomonas aeruginosa (26, 10.7%) and Acinetobacter calcoaceticus (24, 9.9%), respectively [Table - 2].

Sensitivity to gentamicin was assessed in 178 of the culture-positive rims. The analysis is shown in [Table - 3]. Resistance to gentamicin was seen in 113 (63.4%) of the 178 isolates. Amongst gram-positive organisms, the incidence of resistance was 53.8%. Gram-negative organisms" showed resistance to gentamicin in 81.9% of the isolates. The individual species of bacteria showed a varying frequency of occurrence of resistance. Pseudomonas species at 86.2% of the isolates showing resistance to gentamicin had the highest incidence. Streptococcus species at 84.6% and Acinetobacter calcoaceticus at 81.8% also showed a high incidence of gentamicin resistance. Staphylococcus epidermidis, the commonest bacterial isolate showed gentamicin resistance in 50% cases and Staphylococcus aureus had a 57% rate of resistance.


  Discussion Top


Gentamicin is the most frequently used antibiotic in all commercially available corneal storage media today, as it has been proven to be effective against a wide variety of bacteria. It is also used extensively in decontamination of donor globes. Various methods have been tried to minimize bacterial contamination of donor cornea. Irrigation of harvested corneas using either neomycin and polymyxin B solution [8]sub or povidone-iodine [9] has, been shown to markedly decrease the incidence and extent of colonization. Fong et a1 [10] have shown that the use of gentamicin 100 gg/ ml in preservation media reduced the incidence of their donor contamination from 43% in whole globe storage to 14% in M-K and K-Sol stored corneas.

Resistance to gentamicin among ocular pathogens is reported to be on the increase. [11] A comparison of gentamicin resistance in common bacterial contaminants from donor rims in some studies is shown in the Figure. The overall incidence of gentamicin-resistant organisms in our study was 63.4%. This is similar to the range of 49 to 70% reported previously. [3],[12],[13]

The incidence of gentamicin resistance for gram­positive and gram-negative organisms in our study was 53.8% and 81.9%, respectively. In the gram­positive group, Streptococci demonstrated a resistance in 84.6% of isolates. This serves to emphasize the poor activity of gentamicin against Streptococcus species. [14] A variation from the past studies is the increased incidence of Pseudomonas species (16.2%) and its high rate of gentamicin resistance (86.2%). In most of the earlier studies [3],[12],[13 ]Pseudomonas species does not figure in the list of donor rim contaminants.

Baer et all [8] have demonstrated that warming the globe for an hour before intended surgery may not eliminate even sensitive organisms from the donor tissue. Longer periods of preoperative warming may more effectively eradicate bacteria, but their effect on donor corneal tissue is unknown and needs further study.

The relationship of bacteria cultured from corneal storage media or donor cornea and development of postoperative endophthalmitis is not conclusively established. [3] Several studies on donor corneal contamination reveal no postoperative infections [3],[12],[13] Leville et al [15] have, however, reported a 22-fold increased risk of endophthalmitis among recipients of contaminated donor corneas compared to those receiving culture-negative tissue (1.3% vs 0.06%). Kloess et a1 [16] have shown that donor rim cultures were positive in 31(56%) of 55 cases (13 cases with unknown culture status included) of post-penetrating keratoplasty endophthalmitis reviewed by them and that in 30 of these 31 culture-positive donor rims the same organism was isolated from the endophthalmitis and corneal rim cultures. They also reported that in 13 of the 31 cases (32%), the causative bacteria were resistant to gentamicin.

It is apparent from the data that the frequency of contaminated donor tissue relative to that of the incidence of endophthalmitis is much higher. Possibly, most of the bacteria and fungi are eliminated by either one or a combination of the following: action of residual antibiotics from the preservation media; [17] rinsing of the donor cornea before grafting, [7] antibiotics given to the recipient postoperatively, [12],[16] or the host immune response.

In view of the above facts and the definite increase in the incidence of gentamicin resistance documented, we believe that the incidence of endophthalmitis following penetrating keratoplasty can be reduced further by the following measures:

Use of povidone-iodine in the decontamination of donor globes. [9]

Addition of other antibiotics or using those with a broader spectrum of activity in the corneal storage media.

Routine culture of donor rims in all patients as this may provide a guide to early therapy in case of occurrence of infection.

Increased frequency of initial follow-up visits in patients whose donor corneal rim cultures isolate potentially virulent organisms.

Use of antibiotics other than gentamicin during the initial period following penetrating keratoplasty.


  Acknowledgement Top


This study was funded by the Hyderabad Eye Research Foundation, Hyderabad.

 
  References Top

1.
Aiello LP, Canner JK, Javitt JC. National risks of endophthalmitis and retinal detachment following inpatient penetrating keratoplasty. Invest Ophthalmol Vis Sci. 32(suppl):746-750, 1992.  Back to cited text no. 1
    
2.
Kattan HM, Flynn HW Jr; Pflugfelder SC, et al. Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. Ophthalmology. 98:227-231, 1991.  Back to cited text no. 2
    
3.
Farrell PL, Fan JT, Smith RE, et al. Donor corneal bacterial contamination. Cornea. 10:381-386, 1991.  Back to cited text no. 3
    
4.
Pneumococcal endophthalmitis after ocular surgery. MMWR. 39:71, 1990.  Back to cited text no. 4
    
5.
Baum J,Barza M, Kane A. Efficacy of penicillin G, cefazolin, and gentamicin in M-K medium at 4°C. Arch Ophthalmol. 96:1262-1264, 1978.  Back to cited text no. 5
    
6.
Liesgang TJ, Robinson N, Jones DB. Modified tissue culture medium for corneal storage I. Investigation of the effect of antibiotics on bacterial ' contamination. Arch Ophthalmol. 102:619-624, 1984.  Back to cited text no. 6
    
7.
Pardes GJ, Gallagher MA: Microbial contamination of donor eyes: a retrospective study. Arch Ophthalmol. 100:1611-1613, 1982.  Back to cited text no. 7
    
8.
Baer JC, Nirankari VS, Glaros DS. Streptococcal endophthalmitis from contaminated donor corneas after keratoplasty. Clinical and laboratory investigations. Arch Ophthalmol.106:517-520, 1988.  Back to cited text no. 8
    
9.
Mindrup EA, Dubbel PA and Doughmann DJ. Betadine decontamination of donor globes, Cornea. 12:324-329, 1993.  Back to cited text no. 9
    
10.
Fong LP, Gladstone D, Casey TA. Corneoscleral rim cultures: donor contamination - a case of fungal endophthalmitis transmitted by K-sol stored cornea. Eye. 2:670-676, 1988.  Back to cited text no. 10
    
11.
Ormerod LD, Heseltine PNR, Allenso E, et al. Gentamicin- resistant pseudomonas infection. Rationale for a redefinition of ophthalmic antimicrobial sensitivities. Cornea. 8:195-199, 1989.  Back to cited text no. 11
    
12.
Poole TG, Insler MS. Contamination of donor cornea by gentamicin-resistant organisms. Am J Ophthalmol. 97:560-564, 1984.  Back to cited text no. 12
    
13.
Mathers WD, Lemp MA. Corneal rim cultures. Cornea. 6:231-233, 1987.  Back to cited text no. 13
    
14.
Kucers A, Bennett NMcK. The use of antibiotics. A comprehensive review with clinical emphasis. 4th ed, Philadelphia, J.B. Lipincott Co, 1987.  Back to cited text no. 14
    
15.
Leville AS, McMullin FD, Cavanagh HD. Endophthalmitis following penetrating keratoplasty. Ophthalmology.90:38-39, 1983.  Back to cited text no. 15
    
16.
Kloess PM, Stulting D, Waring GO, et al. Bacterial and fungal endophthalmitis after penetrating Keratoplasty. Am J Ophthalmol. 115;309-316, 1993.  Back to cited text no. 16
    
17.
Yab CW, Busin M, Avni I, et al. Antibacterial effect of donor cornea stored in gentamicin-enriched Mc.Carey­Kaufman medium. Arch Ophthalmol. 104:263-267, 1986.  Back to cited text no. 17
    


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]


This article has been cited by
1 Eye banking: An introduction
Rao, G.N., Gopinathan, U.
Community Eye Health Journal. 2009; 22(71): 46-47
[Pubmed]
2 First report of evaluation of K-M media: A new corneal preservation medium
Desai, B.M., Khamar, B.M., Ghodadra, B.K.
Indian Journal of Ophthalmology. 2007; 55(1): 43-47
[Pubmed]
3 Bacterial infection transmitted by human tissue allograft transplantation
Eastlund, T.
Cell and Tissue Banking. 2006; 7(3): 147-166
[Pubmed]
4 Trends in antibiotic resistance of corneal pathogens: Part II. An analysis of leading bacterial keratitis isolates
Sharma, S., Kunimoto, D.Y., Nagaraja Rao, T., Garg, P., Rao, G.N.
Indian Journal of Ophthalmology. 1999; 47(2): 101-109
[Pubmed]
5 Antimicrobial effect of ciprofloxacin, povidone-iodine, and gentamicin in the decontamination of human donor globes
Gopinathan, U., Reddy, M.K., Nadkarni, M.S., Dasari, S., Rao, G.N.
Cornea. 1998; 17(1): 57-61
[Pubmed]
6 Donor corneal tissue evaluation
Saini, J.S., Reddy, M.K., Sharma, S., Wagh, S.
Indian Journal of Ophthalmology. 1996; 44(1): 3-13
[Pubmed]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Materials and me...
Results
Discussion
Acknowledgement
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2916    
    Printed120    
    Emailed4    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 6    

Recommend this journal