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.
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.
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.
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Hassan SS, Wilhelmus KR (2007) Quality assessment and microbiologic screening of donor corneas. Cornea. 26(8):953–955
Gavrilov J-C, Borderie VM, Laroche L, Delbosc B (2010) Influencing factors on the suitability of organ-cultured corneas. Eye 24(7):1227–1233
Fontana L, Errani PG, Zerbinati A, Musacchi Y, Di Pede B, Tassinari G (2007) Frequency of positive donor rim cultures after penetrating keratoplasty using hypothermic and organ-cultured donor corneas. Cornea 26(5):552–556
Rehany U, Balut G, Lefler E, Rumelt S (2004) The prevalence and risk factors for donor corneal button contamination and its association with ocular infection after transplantation. Cornea. 23(7):649–654
Hassan SS, Wilhelmus KR, Dahl P et al (2008) Infectious disease risk factors of corneal graft donors. Arch Ophthalmol 126(2):235–239
Armitage WJ, Jones MNA, Zambrano I, Carley F, Tole DM (2014) The suitability of corneas stored by organ culture for penetrating keratoplasty and influence of donor and recipient factors on 5-year graft survival. Invest Ophthalmol Vis Sci 55:784–791
Khouani M, Debellemanière G, Malugani C et al (2014) Evaluation of microbial contamination of corneal transplants: one-year report from a French regional eye bank. Cornea 33(9):899–904
Armitage WJ, Easty DL (1997) Factors influencing the suitability of organ-cultured corneas for transplantation. Invest Ophthalmol Vis Sci 38(1):16–24
Robert PY, Camezind P, Drouet M, Ploy MC, Adenis JP (2002) Internal and external contamination of donor corneas before in situ excision: bacterial risk factors in 93 donors. Graefes Arch Clin Exp Ophthalmol 240(4):265–270
Gruenert AK, Rosenbaum K, Geerling G, Fuchsluger TA (2017) The influence of donor factors on corneal organ culture contamination. Acta Ophthalmol 95(7):733–740
Hassan SS, Wilhelmus KR (2005) Eye-banking risk factors for fungal endophthalmitis compared with bacterial endopthalmitis after corneal transplantation. Am J Ophthalmol 139(4):685–690
Builles N, Perraud M, Reverdy ME et al (2006) Reducing contamination when removing and storing corneas: a multidisciplinary, transversal, and environmental approach. Cornea 25(2):185–192
Oguido APMT, Casella AMB, Hofling-Lima AL et al (2011) Pseudomonas aeruginosa endophthalmitis after penetrating keratoplasty transmitted from the same donor to two recipients confirmed by pulsed-field gel electrophoresis. J Clin Microbiol 49(9):3346–3347
Kloess PM, Stulting RD, Waring GO III, Wilson LA (1993) Bacterial and fungal endophthalmitis after penetrating keratoplasty. Am J Ophthalmol 115(3):309–316
Sutphin JE, Hollis RJ, Wagoner MD (2002) Donor-to-host transmission of candida albicans after corneal transplantation. Am J Ophthalmol 134(1):120–121
Kitazawa K, Wakimasu K, Yoneda K et al (2017) A case of fungal keratitis and endophthalmitis post penetrating keratoplasty resulting from fungal contamination of the donor cornea. Am J Ophthalmol Case Rep 5:103–106
Serna-Ojeda JC, Pedro-Aguilar L, Rodriguez-Quintanilla C, Graue-Hernandez EO (2018) Post-keratoplasty endophthalmitis by multidrug-resistant pseudomonas aeruginosa with positive culture of the contralateral donor cornea: a case report. Transplant Proc 50(3):964–966
Grzybowski A, Brona P, Kim SJ (2017) Microbial flora and resistance in ophthalmology: a review. Graefes Arch Clin Exp Ophthalmol 255:851–862
Reddy SC, Paul G (2013) Bacterial flora of conjunctiva after death. Int J Ophthalmol 6(5):632–636
Sahin A, Yildirim N, Gultekin S et al (2017) Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit. Arq Bras Oftalmol 80(1):21–24
Chen JY, Jones MN, Srinivasan S et al (2015) Endophthalmitis after penetrating keratoplasty. Ophthalmology 122(1):25–30
Du DT, Wagoner A, Barone SB et al (2014) Incidence of endophthalmitis after corneal transplant or cataract surgery in a medicare population. Ophthalmology 121(1):290–298
Taban M, Behrens A, Newcomb RL, Nobe MY, McDonnell PJ (2005) Incidence of acute endophthalmitis following penetrating keratoplasty: a systematic review. Arch Ophthalmol 123(5):605–609
Edelstein SL, DeMatteo J, Stoeger CG, Macsai MS, Wang CH (2016) Report of the Eye Bank Association of America Medical Review Subcommittee on adverse reactions reported from 2007 to 2014. Cornea 35(7):917–926
Antonios SR, Cameron JA, Badr IA, Habash NR, Cotter JB (1991) Contamination of donor cornea: postpenetrating keratoplasty endophthalmitis. Cornea 10(3):217–220
Cameron JA, Antonios SR, Cotter JB, Habash NR (1991) Endophthalmitis from contaminated donor corneas following penetrating keratoplasty. Arch Ophthalmol 109(1):54–59
Aldave AJ, DeMatteo J, Glasser DB et al (2013) Report of the Eye Bank Association of America Medical Advisory Board Subcommittee on fungal infection after corneal transplantation. Cornea 32(2):149–154
Blanco C, Núñez MX (2010) Endophthalmitis by Pseudomonas aeruginosa after penetrating keratoplasty, case report with an epidemiological investigation. Biomedica 30(3):327–331
Leveille AS, McMullan D, Cavanagh HD (1983) Endophthalmitis following penetrating keratoplasty. Ophthalmology 90(1):38–39
Alharbi SS, Alrajhi A, ALkahtani E (2014) Endophthalmitis following keratoplasty: incidence,microbial profile, visual and structural outcomes. Ocul Immunol Inflamm 22:218–223
Wilhelmus KR, Hassan SS (2007) The prognostic role of donor corneoescleral rim cultures in corneal transplantation. Ophthalmology 114(3):440–445
Eifrig CW, Scott IU, Flynn HW, Miller D (2003) Endophthalmitis caused by Pseudomonas aeruginosa. Ophthalmology 110(9):1714–1717
Shivaramaiah HS, Relhan N, Pathengay A, Mohan N, Flynn HW Jr (2018) Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes. Am J Ophthalmol Case Rep 10:211–214
Tran KD, Yanuzzi NA, Si N et al (2018) Clinical features, antimicrobial susceptibilities, and treatment outcomes of patients with culture positive endophthalmitis after penetrating keratoplasty. Am J Ophthalmol Case Rep 9:62–67
Agência Nacional de Vigilância Sanitária (2015) Resolução da Diretoria Colegiada –RDC N° 55, de 11 de dezembro de 2015. Dispõe sobre as boas práticas em tecidos humanos para uso terapêutico. Diário Oficial da República Federativa do Brasil, Brasília. ;238:55–72. http://www.cevs.rs.gov.br/upload/arquivos/201705/18112318-rdc-55-2015-boas-praticas-em-tecidos-14-12-2015.pdf. Accessed 15 July 2018
Al-Tawfiq JA, Tambyah PA (2014) Healthcare associated infections (HAI) perspectives. J Infect Public Health 7(4):339–344
Vincent JL, RelloJ MJ et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302(21):2323–2329
Remschmidt C, Schröder C, Behnke M et al (2018) Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany: 10 years of surveillance. Antimicrob Resist Infect Control 7:54
Armitage WJ (2011) Preservation of human cornea. Transfus Med Hemother 38(2):143–147
Eye Bank Association of America (2017) E1.100 Recovery. In: Procedures Manual, June 2017. Washington,DC, pp 32–42 http://restoresight.org/wp-content/uploads/2017/07/EBAA-ProcMan-June-2017.pdf Acessed 10 January 2020
Rosenwasser GOD, Nicholson WJ (2003) Introduction to eye banking: a handbook and atlas. A guide to eye bank techniques, corneal evaluation and grading. P.33-40
Sousa SJF, Sousa SBF (2018) Eye bank procedures: donor selection criteria. Arq Bras Oftalmol 81(1):73–79
CLSI (2018) Performance standards for antimicrobial susceptibility testing, 28th ed. Clinical and Laboratory Standards Institute, Wayne http://www.facm.ucl.ac.be/intranet/CLSI/CLSI-2018-M100-S28-unlocked.pdf. Accessed Jan 2018
Röck T, Landenberger J, Buhl M et al (2018) Factors influencing the contamination rates of the conjunctival swabs and organ culture media of human donor eyes. Medicine 97(38):1–6
Khan HA, Ahmad A, Mehboob R (2015) Nosocomial infections and their control strategies. Asian Pac J Trop Biomed 5(7):509–514
Dereli N, Ozayar E, Degerli S, Sahin S, Koç F (2013) Three-year evaluation of nosocomial infection rates of the ICU. Rev Bras Anestesiol 63(1):73–78
Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez et al (2015) The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit. Int J Infect Dis 31:31–34
Oliveira AC, Kovner CT, Silva RS (2010) Nosocomial infection in an intensive care unit in a Brazilian university hospital. Rev Lat Am Enfermagem 18(2):233–239
Seedor JA, Stulting RD, Epstein RJ et al (1987) Survival of corneal grafts from donors supported by mechanical ventilation. Ophthalmology. 94(2):101–108
Karjalainen K, Vannas A (1984) Bacterial contamination of donor corneas. Ophthalmic Surg 15(9):770–772
Tandon R, Mehta M, Satpathy G et al (2008) Microbiological profile of donor corneas: a retrospective study from an eye bank in North India. Cornea 27(1):80–87
Röck D, Wude J, Bartz-Schmidt KU et al (2017) Factors influencing the contamination rate of human organ-cultured corneas. Acta Ophthalmol 95(8):706–702
Zanetti E, Bruni A, Mucignat G et al (2005) Bacterial contamination of human organ-cultured corneas. Cornea 24(5):603–607
Patel HY, Brookes NH, Moffat L et al (2005) The New Zealand National Eye Bank study 1991-2003: a review of the source and management of corneal tissue. Cornea 24(5):576–582
Li S, Bischoff M, Schirra F et al (2014) Correlation between microbial growth in conjunctival swabs of corneal donors and contamination of organ culture media. Ophthalmologe 111(6):553–559
Inomata T, Ono K, Matsuba T et al (2017) Pre-banking microbial contamination of donor conjunctiva and storage medium for penetrating keratoplasty. Jpn J Ophthalmol 61(5):369–377
Linke SJ, Fricke OH, Eddy M et al (2013) Risk factors for donor cornea contamination: retrospective analysis of 4546 procured corneas in a single eye bank. Cornea 32(2):141–148
Röck T, Hofmann J, Thaler S, Bramkamp M, Bartz-Schmidt KU, Yoeruek E et al (2016) Factors that influence the suitability of human organ-cultured corneas. Graefes Arch Clin Exp Ophthalmol 254(1):135–141. https://doi.org/10.1007/s00417-015-3119-7
Albon J, Armstrong M, Tullo AB (2001) Bacterial contamination of human organ-cultured corneas. Cornea 20(3):260–263
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Comitê de Ética em Pesquisa Envolvendo Seres Humanos da Universidade Estadual de Londrina- number 2.150.760) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Medina, I.F.B., Oguido, A.P.M.T., Urbano, M.R. et al. Intensive care unit time and prolonged enucleation to processing interval are associated with donor cornea contamination. Graefes Arch Clin Exp Ophthalmol (2020). https://doi.org/10.1007/s00417-020-04758-w
- Intensive care unit