Efficacy of Picloxidine and Staphylococcal Bacteriophage in Preoperative Eradication of Staphylococcus Epidermidis

In view of the current trend — growth of antibiotic resistance, the search for possible alternative methods of preoperative prophylaxis is relevant.

The purpose: to assess the impact of different methods of preoperative eradication of Staphylococcus epidermidis (the use of specific bacteriophage and picloxidine in combination with eyelid massage) on conjunctival and aqueous moisture contamination in the course of planned phacoemulsification.

Patients and Methods. 44 patients (48 eyes) were examined. Patients in group I underwent eradication with staphylococcal bacteriophage in combination with eyelid massage, in group II — with picloxidine according to the similar technique, group III was control group. Microbiological material was sampled from the conjunctival cavity before the application of the said methods and after blepharostat placement. Anterior chamber fluid (ACF) was examined at the end of the operation. Microorganisms were identified by MALDI-TOF method, sensitivity was determined by drip method.

Results. The percentage of S. epidermidis contamination of conjunctiva after blepharostat placement was 25.0 %, 68.8 % and 87.5 % in groups I, II, III, respectively, in the ACF it was found in 0.0 %, 12.5 % and 37.5 % in groups I, II, III, respectively.

Conclusion. Preoperative measures for S. epidermidis eradication with staphylococcal bacteriophage in combination with eyelid massage are significantly more effective than the similar technique with picloxidine and provide a significant reduction of conjunctival sac contamination by 75 %, and also absence of S. epidermidis in the ACF by the time of phacoemulsification completion.

1. Simina DS, Larisa I, Otilia C, Ana Cristina G, Liliana MV, Aurelian MG. The ocular surface bacterial contamination and its management in the prophylaxis of post cataract surgery endophthalmitis. Rom J Ophthalmol. 2021 JanMar;65(1):2–9. doi: 10.22336/rjo.2021.2.

2. Barry P, Cordoves L, Susanne G. ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery: Data, Dilemmas and Conclusions 2013. https://www.escrs.org/endophthalmitis/

3. Willcox MD. Characterization of the normal microbiota of the ocular surface. Exp Eye Res. 2013 Dec;117:99–105. doi: 10.1016/j.exer.2013.06.003. Epub 2013 Jun 22

4. Sohajda Z, Mályi K. Multirezisztens kórokozók szűrése szürkehályogműtét előtt [Screening for multiresistant pathogens before cataract surgery]. Orv Hetil. 2021 Jan 17;162(3):106–111. Hungarian. doi: 10.1556/650.2021.31941.

5. Nejima R, Shimizu K, Ono T, Noguchi Y, Yagi A, Iwasaki T, Shoji N, Miyata K. Effect of the administration period of perioperative topical levofloxacin on normal conjunctival bacterial flora. J Cataract Refract Surg. 2017 Jan;43(1):42–48. doi: 10.1016/j.jcrs.2016.10.024. PMID: 28317676.

6. Kato JM, Tanaka T, de Oliveira LMS, de Oliveira MS, Rossi F, Goldbaum M, Pimentel SLG, de Almeida Junior JN, Yamamoto JH. Surveillance of postcataract endophthalmitis at a tertiary referral center: a 10year critical evaluation. Int J Retina Vitreous. 2021 Feb 16;7(1):14. doi: 10.1186/s40942-021-00280-1.

7. Bogdanova TYu, Kulikov AN, Danilenko EV, Kraeva LA. Research of Bacterial Contamination of The Surgical Field During Phacoemulsification. Ophthalmology in Russia. 2024;21(2):303–310 (In Russ.). doi: 10.18008/1816-5095-2024-2-303-310.

8. Ye T, Chen W, Congdon N, Liu Y. Increase in microbial contamination risk with compression of the lid margin in eyes having cataract surgery. J Cataract Refract Surg. 2014 Aug;40(8):1377–1381. doi: 10.1016/j.jcrs.2013.11.046.

9. Inagaki K, Yamaguchi T, Ohde S, Deshpande GA, Kakinoki K, Ohkoshi K. Bacterial culture after three sterilization methods for cataract surgery. Jpn J Ophthalmol. 2013 Jan;57(1):74–79. doi: 10.1007/s10384-012-0201-0. Epub 2012 Oct 19.

10. Suzuki T, Tanaka H, Toriyama K, Okamoto S, Urabe K, Hashida M, Shinkai Y, Ohashi Y. Prospective clinical evaluation of 1.5 % levofloxacin ophthalmic solution in ophthalmic perioperative disinfection. J Ocul PharmacolTher. 2013 Dec;29(10):887–892. doi: 10.1089/jop.2013.0146. Epub 2013 Nov 1. PMID: 24180629.

11. Shilovskikh OV, Kazaykin VN, Ponomaryov VO, Novoselova TN, Kleymenov AYu, Kazantsev VG, Markina OA, Dzhapakova AV. Efficacy of antibacterial drugs instillations in suppression of conjunctival microflora before operations on the eyeball. Practical Medicine. 2017;9(110):196–201 (In Russ.).

12. Miyanaga M, Nejima R, Miyai T, Miyata K, Ohashi Y, Inoue Y, Toyokawa M, Asari S. Changes in drug susceptibility and the quinoloneresistance determining region of Staphylococcus epidermidis after administration of fluoroquinolones. J Cataract Refract Surg. 2009;35:1970–1978. doi: 10.1016/j.jcrs.2009.05.049.

13. Yin VT, Weisbrod DJ, Eng KT, Schwartz C, Kohly R, Mandelcorn E, Lam WC, Daneman N, Simor A, Kertes PJ. Antibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection. JAMA Ophthalmol 2013;131:456–461. doi: 10.1016/j.jcrs.2014.06.042.

14. Okolov IN. Monitoring antimicrobial activity of antiseptic eye drops. Ophthalmology journal. 2019;12(3):67–74 (In Russ.). doi: 10.17816/OV16300.

15. Khalatyan AS, Budzinskaya MV, Kholina EG, Strakhovskaya MG, Kolyshkina NA, Kovalenko IB, Zhukhovitsky VG. Sensitivity of Antibiotic Resistant Coagulase Negative Staphylococci to Antiseptic Piсloxydin. Journal of Clinical Practice. 2020;11(1):42–48 (In Russ.). doi: 10.17816/clinpract17543.

16. Pirogov YI, Shustrova TA, Oblovatskaya ES, Khromova ES. The state of conjunctival flora and its susceptibility to “Vitabakt” in cataract patients compared to other antibiotics used in ophthalmologic practice. Ophthalmology Journal. 2018;11(2):75–79 (In Russ.). doi: 10.17816/OV11275-79.

17. Aslanov BI. Bacteriophages are effective antibacterial agents in the context of global antibiotic resistance. Meditsinskiy Sovet. 2015;(13):106–111 (In Russ.). doi: 10.21518/2079-701X-2015-13-106-111.

18. Bogdanova TYu, Kulikov AN, Danilenko EV, Kraeva LA. Method of eradication of S.epidermidis before planned cataract phacoemulsification. Patent RU 2804582, 02.10.2023 (In Russ.).