These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-1gq1adk8ux.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery

The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.

Coagulase-Negative Staphylococci

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-yxd0y9e4ks.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery.

Natural History of Central Retinal Vein Occlusion: An Evidence-Based Systematic Review

Structural Grading of Foveal Hypoplasia Using Spectral-Domain Optical Coherence Tomography a Predictor of Visual Acuity?

Objective To analyze the microbiologic spectrum and in vitro susceptibility profiles over the last 11 years of organisms isolated from the vitreous of patients with endophthalmitis following cataract surgery. Methods Records of 497 consecutive patients treated at 1 institution for clinically suspected endophthalmitis following cataract surgery from July 1989 through June 2000 were reviewed. Results of microbiologic culture and in vitro antibiotic susceptibility testing from the periods 1989 to 1994 and 1995 to 2000 were compared. Results Between the 2 periods, there was a significant increase in the incidence of gram-positive bacteria (92%-97% of bacterial isolates). There was a significant increase in resistance among all bacterial isolates to ciprofloxacin (23%-37%;P = .02). There was increased resistance among coagulase-negative staphylococci to both ciprofloxacin (20%-38%) and cefazolin (19%-40%). Resistance to bacitracin, trimethoprim-sulfamethoxazole, and vancomycin remained unchanged. Vancomycin retained in vitro efficacy against more than 99% of gram-positive bacteria. Ceftazidime was effective against 100% of gram-negative bacteria tested. Conclusions The spectrum of pathogens causing postcataract endophthalmitis is changing, and resistance to antibiotics used for its prophylaxis has grown. These findings may affect the empirical treatment of postcataract endophthalmitis, as well as the use and choice of antibiotics in patients undergoing cataract surgery.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/416894/ecs30238.pdf

Changing trends in the microbiologic aspects of postcataract endophthalmitis.

Objective To describe the clinical course of patients 55 years and younger withcentral retinal vein occlusion (CRVO). Design and Methods Retrospective, noncomparative case series. Medical records of 67 patientswere reviewed for demographic, photographic, clinical, and visual acuity (VA)data. Data from 57 patients with at least 6 months of follow-up (mean, 29.2months) were analyzed statistically. Main Outcome Measures Best-corrected visual acuity and incidence of intraocular neovascularization. Results Of 67 consecutive patients (55% men; mean age, 45 years), the medianpresenting VA was 20/50. Forty-five patients (67%) were found to have at least1 systemic disease. In 57 patients with at least 6 months of follow-up, thefinal VA was 20/40 or better in 42%, 20/50 to 20/100 in 18%, and 20/200 orworse in 40%. Visual decline was most common within 3 to 6 months of CRVOonset. Visual improvement was uncommon after 12 months. Of the 22 patientswith a presenting VA of 20/40 or better, 36% declined to 20/400 or worse atthe most recent examination. Of the 10 patients with a presenting VA of 20/200to 20/400, 8 improved to 20/60 or better. None of the 6 patients with a presentingVA of counting fingers or worse improved. Intraocular neovascularization wasdiagnosed at 1 to 9 months following CRVO in 10 patients (18%). Neovascularizationof the anterior segment developed in 6 patients (11%), including neovascularglaucoma in 3 (5%). The occurrence of neovascularization appeared to be unrelatedto sex, age, presence of associated disease, duration of symptoms, or presentingVA. Conclusions Younger patients with CRVO have a variable clinical course. PresentingVA does not appear to be predictive of visual or anatomic outcome. As a significantnumber of patients with good vision at presentation develop legal blindness,therapeutic intervention during periods of visual decline may be consideredin these patients.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/416165/ecs30119.pdf

Cynthia A. Carvalho-Recchia

Papers

Changing trends in the microbiologic aspects of postcataract endophthalmitis.

Clinical course of younger patients with central retinal vein occlusion.

Optical Coherence Tomography in the Diagnosis of Foveal Hypoplasia