Infection Rates Comparing Topical Antibiotic versus Antibiotic-Free Ointment in Blepharoplasty Surgery

Abstract

Introduction: The purpose of the study was to determine the rate of postoperative surgical-site infections following blepharoplasty by comparing patients using topical antibiotic ointment and those using topical lubricating ointment without antibiotic. Materials and Methods: In an observational, cohort study, 2 similar groups of patients were evaluated for rates of allergic reactions and postoperative infections. For 15 months, 384 consecutive patients, (171 men, 213 women; age range = 38 to 87 years; mean age = 69.2 years), underwent bilateral upper eyelid blepharoplasty. Postoperatively, patients applied bacitracin ophthalmic ointment twice a day for 7 days. Patients with a known allergy to bacitracin were excluded. For the subsequent 9 months, a second cohort of 158 patients, (64 men, 94 women; age range = 30 to 96 years; mean age= 69.3 years) used sterile Refresh PM ophthalmic ointment twice a day for 7 days. All patients had surgery at 1 of 2 fully accredited surgery centers. Both cohorts underwent identical betadine preparations, and all procedures were performed under sterile conditions with full gloves, gowns, and drapes. Surgical technique, instruments, and suture materials were consistent in both groups. Patients were seen 1 week following surgery. Results: In the bacitracin group, 14 of 384 (3.65%) patients had an allergic reaction to the ointment characterized by bilateral erythema, swelling, and itching without any evidence of purulent material along the incision line. In 1 patient (0.26%) a positive culture indicated infection with a methicillin-sensitive Staphylococcus species. In the group using Refresh PM, 10 of 158 (6.3%) patients had a culture-positive surgical-site infection characterized by erythema and purulent material along the incisions. All but 1 infection was bilateral. All cultures grew community-acquired methicillin-resistant Staphylococcus aureus. The study was discontinued in light of the high incidence of infection. Conclusions: In these very similar age-matched cohorts, a lower rate of infection (P < .001) was identified in patients using topical antibiotic ointment postoperatively.