Abstract
Purpose: Effect of combination of various antibiotics on Staphylococcus epidermidis biofilm.
 Study design: Experimental study.
 Methods: The biofilm-producing strains of S. epidermidis were isolated from 100 patients undergoing cataract surgery before instillation of any antibiotic. The strains were subjected to sensitivity test to various antibiotic combinations. The most effective agent was selected and its minimum inhibitory concentration was determined by broth dilution method. The statistics wereperformed using SPSS Version 23 (IBM Corp.) and Chi square test.
 Results: A total of 22 biofilm-positive samples were obtained. The combinations of vancomycin with ceftazidime (p < 0.05) followed by moxifloxacin with cefuroxime (p < 0.05) were found to be the most effective. Antibiofilm activity was also shown by other antibiotic combination. The minimum inhibitory concentration of vancomycin and ceftazidime in 11 samples was 2.5 and 2.8 mg/ml, while in the rest of the samples, it was 2.5 and 5.6 mg/ml, respectively. The minimum inhibitory concentration of moxifloxacin and cefuroxime was 0.125 and 2.81 mg/ml, respectively.
 Conclusion: In our study, we conclude that antibiotics are effective in eradicating biofilms.
Highlights
The postoperative endophthalmitis is the most devastating complication after cataract surgery
This study was undertaken to find the role of various antibiotics in prevention of S. epidermidis-producing biofilms on intraocular lenses (IOLs) and is first of its kind, thereby highlighting the importance of prophylaxis against endophthalmitis in patients undergoing cataract surgery
We had already conducted study on the adhesion of biofilm-forming S. epidermidis strains on IOLs.[7]
Summary
The postoperative endophthalmitis is the most devastating complication after cataract surgery. Coagulase-negative Staphylococcus epidermidis bacteria has been recognized as the most common organism isolated from the cases of postoperative endophthalmitis.[1] S. epidermidis is the main commensal bacterium found on human skin, conjunctiva, and eyelids. It is nowadays seen as an important opportunistic pathogen and causative agent for nosocomial infections, similar to Staphylococcus aureus (Centers for Disease Control and Prevention, National Nosocomial Infection Surveillance, 2004). Vancomycin is a glycopeptide and covers gram-positive bacteria, whereas ceftazidime and aminoglycosides like tobramycin and amikacin cover gram-negative bacteria It has been shown in various studies that bacterial contamination occurs during implantation of intraocular lenses (IOLs) and it can be prevented by antibiotic prophylaxis. The aim of our study was to see various antibiotics in combination on the inhibition of biofilm by S. epidermidis in patients undergoing cataract surgery and prevention of occurrence of postoperative endophthalmitis
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