Cargando…

Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis

BACKGROUND: Artificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2–17% of eyes. Long-term vancomycin drops are recommended following ke...

Descripción completa

Detalles Bibliográficos
Autores principales: Konstantopoulos, Aris, Tan, Xiao Wei, Goh, Gwendoline Tze Wei, Saraswathi, Padmanabhan, Chen, Liyan, Nyein, Chan Lwin, Zhou, Lei, Beuerman, Roger, Tan, Donald Tiang Hwee, Mehta, Jod
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604170/
https://www.ncbi.nlm.nih.gov/pubmed/26460791
http://dx.doi.org/10.1371/journal.pone.0139653
_version_ 1782395018997137408
author Konstantopoulos, Aris
Tan, Xiao Wei
Goh, Gwendoline Tze Wei
Saraswathi, Padmanabhan
Chen, Liyan
Nyein, Chan Lwin
Zhou, Lei
Beuerman, Roger
Tan, Donald Tiang Hwee
Mehta, Jod
author_facet Konstantopoulos, Aris
Tan, Xiao Wei
Goh, Gwendoline Tze Wei
Saraswathi, Padmanabhan
Chen, Liyan
Nyein, Chan Lwin
Zhou, Lei
Beuerman, Roger
Tan, Donald Tiang Hwee
Mehta, Jod
author_sort Konstantopoulos, Aris
collection PubMed
description BACKGROUND: Artificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2–17% of eyes. Long-term vancomycin drops are recommended following keratoprosthesis to prevent bacterial keratitis. Evidence, though, in support of this practice is poor. We investigated whether prophylactic vancomycin drops prevented bacterial keratitis in an animal keratoprosthesis model. METHODOLOGY: Twenty-three rabbits were assigned either to a prophylactic group (n = 13) that received vancomycin 1.4% drops 5 times/day from keratoprosthesis implantation to sacrifice, or a non-prophylactic group (n = 10) that received no drops. All rabbits had Staphylococcus aureus inoculation into the cornea at 7–12 days post-implantation and were sacrificed at predetermined time-points. Prophylactic and non-prophylactic groups were compared with slit-lamp photography (SLP), anterior segment optical coherence tomography (AS-OCT), and histology, immunohistochemistry and bacterial quantification of excised corneas. Corneal vancomycin pharmacokinetics were studied in 8 additional rabbits. RESULTS: On day 1 post-inoculation, the median SLP score and mean±SEM AS-OCT corneal thickness (CT) were greater in the non-prophylactic than the prophylactic group (11 vs. 1, p = 0.049 and 486.9±61.2 vs. 327.4±37.1 μm, p = 0.029 respectively). On days 2 and 4, SLP scores and CT were not significantly different. Immunohistochemistry showed a greater CD11b+ve/non-CD11b+ve cell ratio in the non-prophylactic group (1.45 vs. 0.71) on day 2. Bacterial counts were not significantly different between the two groups. Corneal vancomycin concentration (2.835±0.383 μg/ml) exceeded minimum inhibitory concentration (MIC) for Staphylococcus aureus only after 16 days of vancomycin drops. Two of 3 rabbits still developed infection despite bacterial inoculation after 16 days of prophylactic drops. CONCLUSIONS: Prophylactic vancomycin drops provided short-term benefit, but did not prevent infection. Achieving MIC in the cornea was not sufficient to prevent Staphylococcus aureus keratitis. Patients should continue to be counselled regarding the risk of infection following keratoprosthesis.
format Online
Article
Text
id pubmed-4604170
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-46041702015-10-20 Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis Konstantopoulos, Aris Tan, Xiao Wei Goh, Gwendoline Tze Wei Saraswathi, Padmanabhan Chen, Liyan Nyein, Chan Lwin Zhou, Lei Beuerman, Roger Tan, Donald Tiang Hwee Mehta, Jod PLoS One Research Article BACKGROUND: Artificial cornea transplantation, keratoprosthesis, improves vision for patients at high risk of failure with human cadaveric cornea. However, post-operative infection can cause visual loss and implant extrusion in 3.2–17% of eyes. Long-term vancomycin drops are recommended following keratoprosthesis to prevent bacterial keratitis. Evidence, though, in support of this practice is poor. We investigated whether prophylactic vancomycin drops prevented bacterial keratitis in an animal keratoprosthesis model. METHODOLOGY: Twenty-three rabbits were assigned either to a prophylactic group (n = 13) that received vancomycin 1.4% drops 5 times/day from keratoprosthesis implantation to sacrifice, or a non-prophylactic group (n = 10) that received no drops. All rabbits had Staphylococcus aureus inoculation into the cornea at 7–12 days post-implantation and were sacrificed at predetermined time-points. Prophylactic and non-prophylactic groups were compared with slit-lamp photography (SLP), anterior segment optical coherence tomography (AS-OCT), and histology, immunohistochemistry and bacterial quantification of excised corneas. Corneal vancomycin pharmacokinetics were studied in 8 additional rabbits. RESULTS: On day 1 post-inoculation, the median SLP score and mean±SEM AS-OCT corneal thickness (CT) were greater in the non-prophylactic than the prophylactic group (11 vs. 1, p = 0.049 and 486.9±61.2 vs. 327.4±37.1 μm, p = 0.029 respectively). On days 2 and 4, SLP scores and CT were not significantly different. Immunohistochemistry showed a greater CD11b+ve/non-CD11b+ve cell ratio in the non-prophylactic group (1.45 vs. 0.71) on day 2. Bacterial counts were not significantly different between the two groups. Corneal vancomycin concentration (2.835±0.383 μg/ml) exceeded minimum inhibitory concentration (MIC) for Staphylococcus aureus only after 16 days of vancomycin drops. Two of 3 rabbits still developed infection despite bacterial inoculation after 16 days of prophylactic drops. CONCLUSIONS: Prophylactic vancomycin drops provided short-term benefit, but did not prevent infection. Achieving MIC in the cornea was not sufficient to prevent Staphylococcus aureus keratitis. Patients should continue to be counselled regarding the risk of infection following keratoprosthesis. Public Library of Science 2015-10-13 /pmc/articles/PMC4604170/ /pubmed/26460791 http://dx.doi.org/10.1371/journal.pone.0139653 Text en © 2015 Konstantopoulos et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Konstantopoulos, Aris
Tan, Xiao Wei
Goh, Gwendoline Tze Wei
Saraswathi, Padmanabhan
Chen, Liyan
Nyein, Chan Lwin
Zhou, Lei
Beuerman, Roger
Tan, Donald Tiang Hwee
Mehta, Jod
Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title_full Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title_fullStr Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title_full_unstemmed Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title_short Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
title_sort prophylactic vancomycin drops reduce the severity of early bacterial keratitis in keratoprosthesis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604170/
https://www.ncbi.nlm.nih.gov/pubmed/26460791
http://dx.doi.org/10.1371/journal.pone.0139653
work_keys_str_mv AT konstantopoulosaris prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT tanxiaowei prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT gohgwendolinetzewei prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT saraswathipadmanabhan prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT chenliyan prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT nyeinchanlwin prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT zhoulei prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT beuermanroger prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT tandonaldtianghwee prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis
AT mehtajod prophylacticvancomycindropsreducetheseverityofearlybacterialkeratitisinkeratoprosthesis