Topical Ocular Anesthetics Harbour Clinically Important Microbes

Purpose: The study was to determine clinically important microbial contaminants of topical ocular anesthetic medications used in eye centers in Ghana. Methods: A cross-section of eye clinics was sampled for the topical ocular anesthetic agents. Standard laboratory procedures and protocols were observed in culturing the samples on different Agars. Microscopy and various biochemical tests were performed to identify microbial species. Antimicrobial susceptibility tests were also performed to ascertain the clinical importance of the isolated microbes. Results: A total of 27 anesthetic agent were obtained (which consisted 15 Proparacaine and 12 Amethocaine), from which 87 bacteria were isolated which included Bacilli spp. 26(29.89%), Coagulase Negative Staphylococci spp. 17(19.54%), Moraxella spp. 17(19.54%), Staphylococcus aureus 8(9.19%), Streptococcus spp. 3(3.45%), Klebsiella spp. 3(3.45%), Pseudomonas spp. 1(1.15%), Proteus spp. 7(8.05%), Escherichia coli. 2(2.30%), and Shigella spp. 3(3.45%). There were 22 isolated fungal contaminants mainly Penicillium spp. 7(31.82%), Cephalosporium spp. 5(22.73%), Aspergillus spp 4(18.18%), Cercospora spp. 2(9.09%), and Cladosporium spp. 4(18.18%). The anesthetic agent with the most bacterial contamination was Proparacaine 44(50.57%) followed by Amethocaine 43(49.43%). Also, both agents were equally contaminated with fungus 11(50.0%) in each. Gentamicin was the only antibiotics that showed 100% activity against all the bacterial isolates. Fungal contaminants were more susceptible to Ketoconazole as compared to Fluconazole (p≤0.05). Conclusion: Topical ocular anesthetic preparations used in clinical setings in Ghana are contaminated with clinically important microbes as the isolated bacteria were susceptible only to Gentamicin and fungi to Ketoconazole and Fluconazole.Keywords: Anesthetics, Ocular infections, Amethocaine, Proparacain

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran