Eyeworld

95 EW RESIDENTS February 2015 developing virulent endophthalmitis may not be appropriate. Moreover, the other risk factors could not be adequately analyzed with the limit- ed sample size in the study. The authors are to be congrat- ulated for shedding light on the ever-growing concern about the presence of multidrug-resistant organisms as part of our normal flora and the potential implications during preoperative risk assessment. Above all, the study highlights the need for a study powered to identify risk factors not only for colonization but also for development of endoph- thalmitis secondary to oxacillin-re- sistant organisms. As a clinician, risk stratification of patients is an important consideration, and this study adds meaningful data to the conversation. However, modification of current practice with the evidence presented in this study may not yet be warranted. EW References 1. Hsu HY, Lind JT, Miller D, Tseng L. Assessment of risk factors for oxacillin- resistant ocular flora in patients undergoing generalizability of the study results. For example, a lower rate of oxacil- lin resistance (37%) was reported in conjunctival cultures at Stanford University. 2 Furthermore, we must consider other techniques for risk reduction when discussing prevention of en- dophthalmitis. For example, the use of povidone-iodine is an important and well-supported deterrent for postoperative endophthalmitis. 11 The studies regarding use of topical, perioperative antibiotics, however, are not as conclusive. 11 Even so, enhancing our knowledge regarding the ocular flora and their sensitivi- ty profiles will allow for improved selection of antibiotic prophylaxis as the role of topical antibiotics and intracameral antibiotics continues to be debated in the scientific forum. As mentioned in the study, post- operative endophthalmitis follow- ing cataract surgery is exceedingly rare with a rate of 0.28 per 1,000 as reported by Wykoff et al. 12 There- fore, extrapolating the data in this study to suggest patients with recent antibiotic use are at a higher risk of oxacillin-resistant ocular flora in Bascom Palmer Eye Institute residents with the chairman and residency program director Source: Bascom Palmer Eye Institute cataract surgery. J Cataract Refract Surg. 2015;41(2):387–392. 2. Mino de Kaspar H, Koss MJ, He L, et al. Antibiotic susceptibility of preoperative normal conjunctival bacteria. Am J Ophthalmol. 2005;139:730–3. 3. Allen HF, Mangiaracine AB. Bacterial endophthalmitis after cataract extraction: II. Incidence in 36,000 consecutive operations with special reference to preoperative topical antibiotics. Arch Ophthalmol.1974;91:3–7. 4. Ariyasu RG, Nakamura T, Trousdale MD, Smith RE. Intraoperative bacterial contamina- tion of the aqueous humor. Ophthalmic Surg. 1993;24:367–73. 5. Romero-Aroca P, Mendez-Marin I, Salvat- Serra M, et al. Results at seven years after the use of intracamerular cefazolin as an en- dophthalmitis prophylaxis in cataract surgery. BMC Ophthalmol. 2012;12:2. 6. Matsuura K, Miyoshi T, Suto C, et al. Efficacy and safety of prophylactic intracameral moxi- floxacin injection in Japan. J Cataract Refract Surg. 2013;39:1702–6. 7. García-Sáenz MC, Arias-Puente A, Rodríguez-Caravaca G, Bañuelos JB. Effectiveness of intracameral cefuroxime in preventing endophthalmitis after cataract surgery: Ten-year comparative study. J Cataract Refract Surg. 2010;36:203–7. 8. Shorstein NH, Winthrop KL, Herrinton LJ. Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department. J Cataract Refract Surg. 2013;39:8–14. 9. Hsu H, Lind JT, Tseng L, Miller D. Ocular flora and their antibiotic resistance patterns in the Midwest: a prospective study of patients undergoing cataract surgery. Am J Ophthal- mol. 2013;155:36–44. 10. Major JC Jr, Engelbert M, Flynn HW Jr, et al. Staphylococcus aureus endophthalmitis: antibiotic susceptibilities, methicillin resis- tance, and clinical outcomes. Am J Ophthal- mol. 2010;149:278–283. 11. Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery: an evidence-based update. Ophthalmology. 2002;109:13–24. 12. Wykoff CC, Parrott MB, Flynn HW Jr, et al. Nosocomial acute onset postoperative endophthalmitis at a university teaching hospital (2002–2009). Am J Ophthalmol. 2010;150:392–8. Contact information Gedde: sgedde@med.miami.edu

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