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Tenley Bower, Divya Narendra, Amy C Nau, Leela Raju; Contact Lens Surveillance Cultures in Patients Wearing Bandage Contact Lenses. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4661.
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To describe surveillance cultures of bandage contact lenses (BCL) in patients with a clinical history requiring a BCL such as Boston type 1 keratoprosthesis (KPro), and peripheral ulcerative keratitis (PUK) and infectious keratitis both of which required cyanoacrylate tissue adhesive application. We analyze the effect of therapeutic versus subtherapeutic prophylactic antibiotic dosing on the patients culture status and its clinical effect on the patients’ ocular course.
An institutional review board-approved retrospective consecutive case review of all patients with a history of requiring a BCL and culture taken from October 1, 2009 until July 1, 2013 were examined.
There are a total of 141 cultures from 28 eyes of 26 patients with 38.5% being female and 61.5% being male. The mean number of cultures per eye was 5 with the mean time from CL insertion to culture being 80 days. The indications for BCL were as follows: KPro 81%, corneal ulcer 11%, peripheral ulcerative keratitis 4%, and pseudophakic bullous keratopathy 4%. Of all cultures, 84% had positive growth and of all the positive cultures, 24% of cultures grew an organism that was resistant to an antibiotic. If culture grew an organism that was resistant to the prophylactic antibiotic the patient was on, 89% of patients were switched to a sensitive antibiotic. All indications for BCL had an equal number of positive/negative culture results. There was no statistically significant difference in the chance of a positive culture or the number of resistances in patients taking therapeutic versus subtherapeutic prophylactic antibiotic dosing.
In our series analyzing surveillance cultures of BCL’s, we show that 84% were culture positive and of these 24% grew organisms that were resistant to an antibiotic. Cultures were used to support therapy changes in 89% of patients suggesting that BCL cultures provide useful information to guide effective prophylaxis and, if infectious complications arise, to guide treatment. Subtherapeutic prophylactic antibiotic dosing does not seem to lead to increased risk of culture resistant organisms or infection. However, subtherapeutic dosing may increase the likelihood of an organism becoming resistant to an antibiotic so subtherapeutic dosing is not recommended particularly in our population of patients with chronic ocular disease.
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