Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Abstract

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods

“…Through the RAND method, the participants discussed different clinical scenarios and elaborated statements based on the published literature and their clinical experience." [30] Example 2 "The OMERACT's [Outcome Measures in Rheumatology] broad definition is useful for understanding results in a clinical trial, in that it exists within a more historic paradigm that seeks to remove effects rather than enhance them. In this role it fails to resolve some of the confusion associated with the multitudes of ways contextual factors are presently defined (specifically, whether internal and external domains are potentially contextual factors).…”

“…One patient partner and one clinician (sports and exercise medicine physician) were authors on the risk factor review, 29 and one additional patient and clinician partner provided feedback on one of the intervention reviews. 30 A patient partner and a clinician (physiotherapist) provided feedback on this manuscript." [25] Example 3 "Patient partners were collaboratively involved at key stages of the study.…”

“…This strategy has been used in previous Delphi studies to help reinforce consensus. [26][27][28][29][30] " [65] Example 2 "All rounds allowed for overall comments at the end of the survey, and the researchers reviewed 1,409, 755, and 188 comments associated with the statements in R1, R2 and R3, respectively, and 1,025 and 2,156 comments associated with the recommendations in R2 and R3, respectively. Summaries of changes based on panellist input from a previous round were available in text boxes next to each statement and recommendation in the subsequent round."…”

ACCORD E&E - ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: guidance and examples to support reporting consensus methods

“…Through the RAND method, the participants discussed different clinical scenarios and elaborated statements based on the published literature and their clinical experience." [18] Example 2.…”

“…[6][7][8][9] However, while studies report on use of PI in context of priority setting, 10 ,11 the conduct of clinical trials 12 and the identification of treatment outcomes, 13 there has been relatively little examination of the values underpinning PI or about capturing and assessing the impact of PI effectively. [14][15][16][17][18] Possible reasons cited for the limited number of studies evaluating the impact of PI are that evaluation is too difficult and that PI is of intrinsic value and as such needs no further justification. 16,[19][20][21] The authors of the present article acknowledge this latter perspective.…”