Low frequency of bacteraemia during eye surgery obviates the need for endocarditis prophylaxis

Congenital Nasolacrimal Duct Obstruction Update Study (CUP Study): Paper 4-Infantile Acute Dacryocystitis (InAD)-Presentation, Management, and Outcomes

PURPOSE

To study the presentation, management, and outcomes of infantile acute dacryocystitis.

METHODS

Retrospective study of infants diagnosed with acute dacryocystitis over a period from June 2016 to December 2019. Data collected include demographics, clinical history, presenting features, management, complications, and outcomes. Treatment provided was intensive medical care followed by early probing under endoscopic guidance. Further interventions, where needed, were performed based on intraoperative findings during probing. Successful outcomes were defined as resolution of infection, subjective relief from epiphora, and anatomical patency determined by a normal fluorescein dye disappearance test.

RESULTS

Twenty-seven eyes of 27 infants were analyzed during the study period. The mean age of infants was 3.26 months, and males were more affected than females (male:female 15:12). The mean duration of symptoms was 4.66 weeks, with 96% (26/27) presenting with symptoms of redness, watering, discharge, and swelling. Preseptal cellulitis was seen in 74% (20/27) infants, lacrimal abscess in 67% (18/27) infants, and lacrimal fistula in 37% (10/27). Most infants had complex congenital nasolacrimal duct obstruction (62%, 13/27), of which 7 also had intranasal cysts. One infant successfully underwent endoscopic dacryocystorhinostomy. At a mean follow-up period of 7.95 months, successful outcomes were observed in 90.4% (19/21) infants. The 2 failed cases were complex congenital nasolacrimal duct obstruction with associated sac diverticula and are scheduled for an endoscopic dacryocystorhinostomy.

CONCLUSION

Infantile acute dacryocystitis is a distinct clinical entity. The outcomes of systemic antibiotics and early probing are excellent.

Pediatric Acute Dacryocystitis

PURPOSE

To review and summarize the symptomatology, microbiology, special clinical entities, management, complications, and outcomes of pediatric acute dacryocystitis.

METHODS

The author performed a PubMed search of all articles published in English on acute dacryocystitis. Pediatric subpopulations of these articles were reviewed along with the scant literature of direct references to neonatal and pediatric acute dacryocystitis. Data reviewed included demographics, presentations, microbiological work up, management, complications, and outcomes.

RESULTS

Acute dacryocystitis is not very common in the pediatric age groups and occurs mostly as a complication of congenital nasolacrimal duct obstruction. The age of onset is usually in the neonatal period with a female preponderance. The clinical spectrum ranges from classic pediatric acute dacryocystitis to meningitis. Staphylococcus aureus is the commonest isolate. Occasionally acquired etiologies and rare organisms like Pantoea sp., Epstein-Barr Virus, and Sporothrix are implicated in the etiopathogenesis. The diagnosis is usually clinical aided by laboratory investigations. Better antibiotics, well-established laboratory techniques and surgical modalities, and improved patient care logistics have contributed to good outcomes; however, complications are still being noted although infrequently.

CONCLUSIONS

Pediatric acute dacryocystitis is a distinct entity with unique features of its own. It is a serious infection that warrants careful evaluation and immediate management. In the era of antibiotic resistance, microbiological work up of Pediatric acute dacryocystitis is very useful for subsequent treatment. Surgical challenges in the pediatric age group are distinct and the outcomes are good if standard protocols are followed.

Bacteremia Following Nasolacrimal Duct Probing: Is There a Role of Preoperative Antibiotic Prophylaxis?

AIM

To study the incidence of nasolacrimal duct probing-induced bacteremia using the metabolic colorimetric sensor technique of blood culture.

METHODS

Prospective, interventional study of all consecutive patients who underwent endoscopic-guided probing for congenital nasolacrimal duct obstruction (CNLDO). All patients were operated by a single surgeon (MJA). Blood was drawn under strict aseptic conditions before and after probing. Blood culture was performed using the BacT/ALERT microbial detection system and the protocols were followed as per the manufacturer and Clinical and Laboratory Standard Institute guidelines. Probing induced bacteremia was defined as a negative pre-probing culture and a positive post-probing culture.

RESULTS

Thirty-one eyes of 25 consecutive patients with CNLDO who underwent probing were studied. The mean age at probing was 27 months. All patients presented with epiphora and occasional discharge. One patient presented with unilateral dacryocele along with an acute dacryocystitis. All the pre and post-probing cultures were negative except for the one with acute dacryocystitis. The subsequent subcultures and identification by VITEK 2 system revealed the bacteremia to be caused by Haemophilus influenzae.

CONCLUSION

Nasolacrimal duct probing does not induce bacteremia in routine CNLDO cases unless there is an associated acute dacryocystitis. Preoperative antibiotic prophylaxis is perhaps not needed for systemically healthy CNLDO patients without an acute dacryocystitis. However, with regards to infantile acute dacryocystitis, further evidence is needed to formulate guidelines on additional preoperative antibiotic prophylaxis other than the routine treatment of infection.

Bacteremia during dacryocystorhinostomy: results of intra-operative blood cultures

Background

The aims of the study are to assess the prevalence of bacteremia during dacryocystorhinostomy (DCR) and to assess whether there is a need for post-operative prophylaxis. Prospective interventional study of 52 consecutive dacryocystorhinostomy performed in 50 patients over a period of 1 year from 2013 to 2014. Blood was drawn under strict aseptic conditions during two separate time points: fashioning of the nasal mucosal and creation of lacrimal sac flaps. The blood was inoculated into two blood culture bottles: the dual media as well as Columbia broth. Following withdrawal of blood, all patients received an intraoperative single dose of a cephalosporin antibiotic. Clean cases of primary acquired nasolacrimal duct obstructions (PANDO) without any sac discharge upon marsupialization (22%, 11/50) were not prescribed routine post-operative prophylaxis, whereas the remaining were prescribed oral antibiotics for 5 days.

Results

The mean age of patients was 41 years (range, 4–61 years). The most common diagnosis (70%, 35/50) was primary acquired nasolacrimal duct obstruction. Acute dacryocystitis was noted in 12% (6/50). External DCR was performed in 65% (34/52) and endoscopic DCR in 35% (18/52) of the cases. All the blood cultures were uniformly negative both in terms of abnormal physical changes in media as well subcultures; 22% (11/50) did not receive post-operative antibiotic prophylaxis. None of the patients developed any signs of wound infections. The anatomical and functional success rate was achieved in 98%.

Conclusions

This study did not find any intraoperative bacteremia during dacryocystorhinostomy and that none had wound infection irrespective of post-operative prophylaxis.

The timing of antibiotic administration in the management of infant dacryocystitis

PURPOSE

To report (1) the prevalence of bacteremia among infants with dacryocystitis and (2) the influence of timing of antibiotic administration on the need for repeat probing in the management of these patients.

METHODS

A retrospective analysis of the hospital records of 25 infants < or =6 weeks of age treated for acute dacryocystitis was conducted, including analysis of laboratory data and outcomes.

RESULTS

Of 22 infants who underwent blood cultures, 5 (22.7%) were bacteremic. Twenty-one of the 25 infants underwent nasolacrimal duct probing. Infants who received preoperative antibiotics were less likely to require a repeat probing than those who did not (6% vs. 80%), and this difference was statistically significant (p = 0.004).

CONCLUSIONS

The high rate of bacteremia in this series of patients and the significantly lower incidence of repeat probing among infants who received preprocedural antibiotics suggests that blood cultures and subsequent administration of intravenous antibiotics should be considered prior to probing of infants with dacryocystitis.