Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis
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 keratoprosthes...
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| creator | 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 S Mehta, Jod |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1371/journal.pone.0139653 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0139653</identifier><identifier>PMID: 26460791</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Animals ; Anterior Eye Segment - drug effects ; Anterior Eye Segment - microbiology ; Anterior Eye Segment - pathology ; Antibiotics ; Bacteria ; Bacterial infections ; Blindness ; Cadavers ; Care and treatment ; CD11b antigen ; Cornea ; Cornea - pathology ; Development and progression ; Extrusion ; Eye (anatomy) ; Eye Infections, Bacterial - drug therapy ; Eye Infections, Bacterial - microbiology ; Eye Infections, Bacterial - prevention & control ; Eye, Artificial ; Glaucoma ; Health aspects ; Health risks ; Histology ; Immunohistochemistry ; Implantation ; Infections ; Inoculation ; Keratitis ; Keratitis - drug therapy ; Keratitis - microbiology ; Keratitis - prevention & control ; Laboratories ; Massachusetts ; Medical care ; Microbial Sensitivity Tests ; Minimum inhibitory concentration ; Ophthalmic Solutions - pharmacokinetics ; Ophthalmic Solutions - pharmacology ; Ophthalmic Solutions - therapeutic use ; Optical Coherence Tomography ; Patient outcomes ; Patients ; Pharmacokinetics ; Pharmacology ; Photography ; Prevention ; Rabbits ; Slit Lamp ; Staphylococcus aureus ; Streptococcus infections ; Surgery ; Titanium ; Tomography ; Tomography, Optical Coherence ; Transplantation ; Vancomycin ; Vancomycin - pharmacokinetics ; Vancomycin - pharmacology ; Vancomycin - therapeutic use ; Visual impairment</subject><ispartof>PloS one, 2015-10, Vol.10 (10), p.e0139653-e0139653</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Konstantopoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Konstantopoulos et al 2015 Konstantopoulos et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b555a7ba10d5da479905107ad6c58eab91f934eb3f884d8409805f1829f4e85d3</citedby><cites>FETCH-LOGICAL-c692t-b555a7ba10d5da479905107ad6c58eab91f934eb3f884d8409805f1829f4e85d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604170/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604170/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23871,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26460791$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Mohan, Rajiv R.</contributor><creatorcontrib>Konstantopoulos, Aris</creatorcontrib><creatorcontrib>Tan, Xiao Wei</creatorcontrib><creatorcontrib>Goh, Gwendoline Tze Wei</creatorcontrib><creatorcontrib>Saraswathi, Padmanabhan</creatorcontrib><creatorcontrib>Chen, Liyan</creatorcontrib><creatorcontrib>Nyein, Chan Lwin</creatorcontrib><creatorcontrib>Zhou, Lei</creatorcontrib><creatorcontrib>Beuerman, Roger</creatorcontrib><creatorcontrib>Tan, Donald Tiang Hwee</creatorcontrib><creatorcontrib>Mehta, Jod S</creatorcontrib><creatorcontrib>Mehta, Jod</creatorcontrib><title>Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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.
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.</description><subject>Analysis</subject><subject>Animals</subject><subject>Anterior Eye Segment - drug effects</subject><subject>Anterior Eye Segment - microbiology</subject><subject>Anterior Eye Segment - pathology</subject><subject>Antibiotics</subject><subject>Bacteria</subject><subject>Bacterial infections</subject><subject>Blindness</subject><subject>Cadavers</subject><subject>Care and treatment</subject><subject>CD11b antigen</subject><subject>Cornea</subject><subject>Cornea - pathology</subject><subject>Development and progression</subject><subject>Extrusion</subject><subject>Eye (anatomy)</subject><subject>Eye Infections, Bacterial - drug therapy</subject><subject>Eye Infections, Bacterial - microbiology</subject><subject>Eye Infections, Bacterial - prevention & control</subject><subject>Eye, Artificial</subject><subject>Glaucoma</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Histology</subject><subject>Immunohistochemistry</subject><subject>Implantation</subject><subject>Infections</subject><subject>Inoculation</subject><subject>Keratitis</subject><subject>Keratitis - drug therapy</subject><subject>Keratitis - microbiology</subject><subject>Keratitis - prevention & control</subject><subject>Laboratories</subject><subject>Massachusetts</subject><subject>Medical care</subject><subject>Microbial Sensitivity Tests</subject><subject>Minimum inhibitory concentration</subject><subject>Ophthalmic Solutions - pharmacokinetics</subject><subject>Ophthalmic Solutions - pharmacology</subject><subject>Ophthalmic Solutions - therapeutic use</subject><subject>Optical Coherence Tomography</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pharmacokinetics</subject><subject>Pharmacology</subject><subject>Photography</subject><subject>Prevention</subject><subject>Rabbits</subject><subject>Slit Lamp</subject><subject>Staphylococcus aureus</subject><subject>Streptococcus infections</subject><subject>Surgery</subject><subject>Titanium</subject><subject>Tomography</subject><subject>Tomography, Optical Coherence</subject><subject>Transplantation</subject><subject>Vancomycin</subject><subject>Vancomycin - pharmacokinetics</subject><subject>Vancomycin - pharmacology</subject><subject>Vancomycin - therapeutic use</subject><subject>Visual impairment</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11v0zAUhiMEYmPwDxBEQkJw0WLHzodvkMYYUDFpaIPdWif-aF25cbGdif573DabGrQLlIskJ8_7On59Tpa9xGiKSY0_LF3vO7DTtevUFGHCqpI8yo4xI8WkKhB5fPB8lD0LYYlQSZqqepodFRWtUM3wcdb-8G692FgQ0Yj8BjrhVhthuvxzqof8SsleqDwuVH6tbpU3cZM7nZ-Dt5v8UxKlEtj8u_IQTTQhT8rdi1t7F5IsmPA8e6LBBvViuJ9kv76c_zz7Nrm4_Do7O72YiIoVcdKWZQl1CxjJUgKtGUMlRjXISpSNgpZhzQhVLdFNQ2VDEWtQqXFTME1VU0pykr3e-66tC3yIJ3BcF5hhxHCRiNmekA6WfO3NCvyGOzB8V3B-zsGnHKzijVYaYV1hUdcUJGoYkxUQWRdtDbhlyevjsFrfrpQUqose7Mh0_KUzCz53tzwlT3GNksG7wcC7370Kka9MEMpa6JTrd_9d0HR2jCb0zT_ow7sbqDmkDZhOu7Su2JryU0owTQyuEjV9gEqXVCsjUi9pk-ojwfuRIDFR_Ylz6EPgs-ur_2cvb8bs2wN2ocDGRXC2j8Z1YQzSPShSSwWv9H3IGPHtKNylwbejwIdRSLJXhwd0L7rrffIX0EoDvQ</recordid><startdate>20151013</startdate><enddate>20151013</enddate><creator>Konstantopoulos, Aris</creator><creator>Tan, Xiao Wei</creator><creator>Goh, Gwendoline Tze Wei</creator><creator>Saraswathi, Padmanabhan</creator><creator>Chen, Liyan</creator><creator>Nyein, Chan Lwin</creator><creator>Zhou, Lei</creator><creator>Beuerman, Roger</creator><creator>Tan, Donald Tiang Hwee</creator><creator>Mehta, Jod S</creator><creator>Mehta, Jod</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20151013</creationdate><title>Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis</title><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 S ; Mehta, Jod</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-b555a7ba10d5da479905107ad6c58eab91f934eb3f884d8409805f1829f4e85d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Analysis</topic><topic>Animals</topic><topic>Anterior Eye Segment - drug effects</topic><topic>Anterior Eye Segment - microbiology</topic><topic>Anterior Eye Segment - pathology</topic><topic>Antibiotics</topic><topic>Bacteria</topic><topic>Bacterial infections</topic><topic>Blindness</topic><topic>Cadavers</topic><topic>Care and treatment</topic><topic>CD11b antigen</topic><topic>Cornea</topic><topic>Cornea - pathology</topic><topic>Development and progression</topic><topic>Extrusion</topic><topic>Eye (anatomy)</topic><topic>Eye Infections, Bacterial - drug therapy</topic><topic>Eye Infections, Bacterial - microbiology</topic><topic>Eye Infections, Bacterial - prevention & control</topic><topic>Eye, Artificial</topic><topic>Glaucoma</topic><topic>Health aspects</topic><topic>Health risks</topic><topic>Histology</topic><topic>Immunohistochemistry</topic><topic>Implantation</topic><topic>Infections</topic><topic>Inoculation</topic><topic>Keratitis</topic><topic>Keratitis - drug therapy</topic><topic>Keratitis - microbiology</topic><topic>Keratitis - prevention & control</topic><topic>Laboratories</topic><topic>Massachusetts</topic><topic>Medical care</topic><topic>Microbial Sensitivity Tests</topic><topic>Minimum inhibitory concentration</topic><topic>Ophthalmic Solutions - pharmacokinetics</topic><topic>Ophthalmic Solutions - pharmacology</topic><topic>Ophthalmic Solutions - therapeutic use</topic><topic>Optical Coherence Tomography</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pharmacokinetics</topic><topic>Pharmacology</topic><topic>Photography</topic><topic>Prevention</topic><topic>Rabbits</topic><topic>Slit Lamp</topic><topic>Staphylococcus aureus</topic><topic>Streptococcus infections</topic><topic>Surgery</topic><topic>Titanium</topic><topic>Tomography</topic><topic>Tomography, Optical Coherence</topic><topic>Transplantation</topic><topic>Vancomycin</topic><topic>Vancomycin - pharmacokinetics</topic><topic>Vancomycin - pharmacology</topic><topic>Vancomycin - therapeutic use</topic><topic>Visual impairment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Konstantopoulos, Aris</creatorcontrib><creatorcontrib>Tan, Xiao Wei</creatorcontrib><creatorcontrib>Goh, Gwendoline Tze Wei</creatorcontrib><creatorcontrib>Saraswathi, Padmanabhan</creatorcontrib><creatorcontrib>Chen, Liyan</creatorcontrib><creatorcontrib>Nyein, Chan Lwin</creatorcontrib><creatorcontrib>Zhou, Lei</creatorcontrib><creatorcontrib>Beuerman, Roger</creatorcontrib><creatorcontrib>Tan, Donald Tiang Hwee</creatorcontrib><creatorcontrib>Mehta, Jod S</creatorcontrib><creatorcontrib>Mehta, Jod</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Konstantopoulos, Aris</au><au>Tan, Xiao Wei</au><au>Goh, Gwendoline Tze Wei</au><au>Saraswathi, Padmanabhan</au><au>Chen, Liyan</au><au>Nyein, Chan Lwin</au><au>Zhou, Lei</au><au>Beuerman, Roger</au><au>Tan, Donald Tiang Hwee</au><au>Mehta, Jod S</au><au>Mehta, Jod</au><au>Mohan, Rajiv R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-10-13</date><risdate>2015</risdate><volume>10</volume><issue>10</issue><spage>e0139653</spage><epage>e0139653</epage><pages>e0139653-e0139653</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26460791</pmid><doi>10.1371/journal.pone.0139653</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-10, Vol.10 (10), p.e0139653-e0139653 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1721910912 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analysis Animals Anterior Eye Segment - drug effects Anterior Eye Segment - microbiology Anterior Eye Segment - pathology Antibiotics Bacteria Bacterial infections Blindness Cadavers Care and treatment CD11b antigen Cornea Cornea - pathology Development and progression Extrusion Eye (anatomy) Eye Infections, Bacterial - drug therapy Eye Infections, Bacterial - microbiology Eye Infections, Bacterial - prevention & control Eye, Artificial Glaucoma Health aspects Health risks Histology Immunohistochemistry Implantation Infections Inoculation Keratitis Keratitis - drug therapy Keratitis - microbiology Keratitis - prevention & control Laboratories Massachusetts Medical care Microbial Sensitivity Tests Minimum inhibitory concentration Ophthalmic Solutions - pharmacokinetics Ophthalmic Solutions - pharmacology Ophthalmic Solutions - therapeutic use Optical Coherence Tomography Patient outcomes Patients Pharmacokinetics Pharmacology Photography Prevention Rabbits Slit Lamp Staphylococcus aureus Streptococcus infections Surgery Titanium Tomography Tomography, Optical Coherence Transplantation Vancomycin Vancomycin - pharmacokinetics Vancomycin - pharmacology Vancomycin - therapeutic use Visual impairment |
| title | Prophylactic Vancomycin Drops Reduce the Severity of Early Bacterial Keratitis in Keratoprosthesis |
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