Microbiological spectrum and probability of transmission of infection from ocular tissues of enucleated eyes harvested from septicemic donors.

Abstract

Background: Tissues from septicemic donor are considered contraindication for transplantation. However, a definite evidence is lacking to link these corneas as a potential source of post-transplantation infection.

Aim: To assess corneal tissue microbiology in septicemic donors and correlate postmortem blood cultures with ocular isolates to determine transplant suitability.

Methods: A bicentric cross-sectional study evaluated 264 eyes from 136 septicemic and non-septicemic donors at two eye banks of tertiary eye centers. Culture report of tissue samples (conjunctival swab, aqueous and vitreous tap, cornea, sclera, and post- mortem blood sample) was compared with the culture results of post-mortem blood samples. Additionally, correlation if any was evaluated between culture positivity of harvested tissue with death to retrieval time. Statistical results were analyzed using Pearson χ ² and Fisher's exact tests.

Results: Among 21 septicemic donors, microbial growth was observed in 28.6%, 7.1%, 9.5%, 4.8%, and 2.4% of non-utilized conjunctival, corneal, scleral, aqueous, and vitreous samples respectively as opposed to 16.7 [odds ratio (OR) = 10.6, 95% confidence interval (CI): 0.938-4.263, P = 0.058], 9.0 (OR = 0.777, 95%CI: 0.141-2.815, P = 0.485), 10.8 (OR = 0.868, 95%CI: 0.207-2.739, P = 0.530), 2.2 (OR = 2.162, 95%CI: 0.199-13.78, P = 0.308) and 1.3% (OR = 1.776, 95%CI: 0.033-22.74, P = 0.502) of 115 non-septicemic donors. Only one tissue of cornea and sclera, yielded the same organism as the blood culture. The microbiological spectrum of pathogens from culture-positive tissues was reflective of commensal pathogens. A strong positive correlation was seen between death to retrieval time in relation to microbial growth.

Conclusion: These findings suggest that sepsis does not significantly impact ocular tissue sterility. Thus, current transplantation guidelines may benefit from further review, particularly in light of the potential to increase the availability of transplantable tissue, consequent to reduced rejection and wastage.