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Lilangi S Ediriwickrema, David Samimi, Brett Bielory, Darlene Miller, Thomas Vincent Johnson; Microbiology and Biofilm Growth on Clinically Infected Silicone Implants within the Lacrimal System: A Thirty Year Review. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4077.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the pathogens and biofilms responsible for clinically significant infection of silicone stents implanted within the lacrimal system.
Retrospective review of culture results for silicone lacrimal stents removed early for clinically significant infection over a thirty year period. As a control, routinely removed, clinically non-infected stents were prospectively sent for culture over a six month period. Four clinically infected stents and six clinically non-infected stents showing mucus within the lumen at removal were sent for scanning electron microscopy to grade the presence of organisms, matrix deposits, organisms within a matrix, and a significant biofilm by a masked electron micrographer.
Nineteen stents were included in the study; 100% of clinically non-infected stents (n=9) and of those removed for infection (n=10) were culture positive. None of the non-infected stents were culture positive for mycobacteria compared with 90% of infected specimens (p < 0.001). Of non-infected stents, 89% grew gram-positive organisms compared with 50% of infected stents (p=0.07). Sixty-seven percent of non-infected stents had gram-negative organisms versus 50% of infected stents (p=0.46). Electron microscopy of the four infected stents revealed organisms consistent with mycobacteria (size, shape) encased within a matrix. Of the six non-infected stents examined, organisms were identified within the lumens that were consistent with culture results but were without clear biofilm formation. A masked electron micrographer was able to identify and grade the presence of organisms, matrix deposits, organisms within a matrix, and a significant biofilm all with statistical significance.
In our study population, atypical mycobacteria comprise the primary pathogen responsible for clinically significant infection of silicone stents in the lacrimal system. Robust biofilm production by this organism likely plays a role in pathogenesis. Development of biofilm resistant implant material, targeted liposomal antibiotic delivery, and physical or chemical disruption strategies are potential methods towards reducing rates of infection.
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