Intensive care unit time and prolonged enucleation to processing interval are associated with donor cornea contamination
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CORNEA
Intensive care unit time and prolonged enucleation to processing interval are associated with donor cornea contamination Isabella Funfas Bandeira Medina 1 & Ana Paula Miyagusko Taba Oguido 2 & Mariana Ragassi Urbano 3 Antônio Marcelo Barbante Casella 1
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Received: 18 November 2019 / Revised: 30 March 2020 / Accepted: 19 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine donor cornea contamination rate and to determine factors associated with cornea contamination. To assess the effect of hospitalization, intensive care unit (ICU) time, and antibiotic use on corneal contamination rate. To determine the spectrum of the contaminating microorganisms. Methods The contamination rate of 212 corneas, obtained by enucleation from April 2014 to January 2015 in a single eye bank, was assessed retrospectively according to age, sex, cause of death, systemic antibiotic use, hospitalization time, ICU time, mechanical ventilation (MV), death to enucleation interval (DEI), enucleation to processing interval (EPI), and corneal epithelial exposure grading. The relative risk (RR) and adjusted RR with a 95% confidence interval were calculated using IBM-SPSS 20.0. Results The contamination rate was 35.6% (n = 75). On multivariate analysis, ICU stay of 4 days or longer and enucleation to processing interval (EPI) greater than 7.4 h (RR 1.58, CI 0.96–2.60, P = 0.06) were associated with donor cornea contamination. Corneal contamination risk was highest from 4 to 6 days at the ICU (RR 3.40, CI 1.54–7.51, P < 0.01) and decreased after 7 days (RR 2.22, CI 1.00–4.93, P = 0.05). Coagulase-negative Staphylococcus was the most common isolated bacteria (69.6%). The frequency of gentamicin-resistant bacteria was higher among patients who stayed 4 days or longer at the ICU. Conclusion Patients staying at the intensive care unit 4 days or longer showed increased risk of corneal contamination. This is an important result to consider further indication for cornea donation. Keywords Cornea . Contamination . Hospitalization . Antibiotics . Intensive care unit . Keratoplasty
Introduction * Isabella Funfas Bandeira Medina [email protected] Ana Paula Miyagusko Taba Oguido [email protected] Mariana Ragassi Urbano [email protected] Antônio Marcelo Barbante Casella [email protected] 1
Postgraduate Program in Health Sciences Center, State University of Londrina (UEL), Londrina, PR, Brazil
2
Department of Surgery, Ophthalmology, State University of Londrina (UEL), Londrina, PR, Brazil
3
Department of Statistics, State University of Londrina (UEL), Londrina, PR, Brazil
Risk factors for donor cornea contamination are controversial [1–4]. Death causes, such as cancer [4–7] and sepsis [6, 8, 9], and prolonged interval between death and harvesting [8–10] and between retrieval and tissue preservation [2, 5, 11] are the most frequently reported. But there is little information regarding the influence of hospitalization on corneal contamination rate [5, 10]. Also, to our knowledge,
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