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Retrospective study in 608 cases on the rate of surgical site infections after orbital surgery without prophylactic systemic antibiotics
  1. Ronald Olaf Björn de Keizer,
  2. Genesis Kozdras,
  3. René Wubbels,
  4. Willem A Van den Bosch,
  5. Dion Paridaens
  1. Oculoplastic and Orbital Service, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
  1. Correspondence to Ronald Olaf Björn de Keizer, The Rotterdam Eye Hospital, Oculoplastic and Orbital Service, Rotterdam, The Netherlands; r.dekeizer{at}


Objective To determine postoperative surgical site infection (SSI) rates in three separate patient groups who underwent orbital surgery without prophylactic systemic antibiotics.

Study design Single-centre retrospective descriptive case series.

Study population We studied the notes of 639 consecutive patients who had undergone orbital surgery in our hospital from 2009 through 2013. All patients belonged to either of three groups: (1) clean orbital surgery (n=226); (2) clean orbital surgery with implant (n=290); (3) clean-contaminated surgery (n=92). Thirty-one patients were excluded.

Results Of the total of 608 patients, without systemic antibiotic prophylaxis, only five were diagnosed with SSI 5/608 (0.82%): 1/226 in the ‘clean’ group, 3/290 in the ‘clean-with-implant’ group and 1/92 in the ‘clean-contaminated’ group. All five patients with SSI were effectively treated with antibiotics.

Conclusion In this study ‘clean’, ‘clean-with-implant’ and ‘clean-contaminated’ orbital surgery was safely performed without prophylactic antibiotics. Where postoperative infection did occur, the patients were effectively treated with systemic antibiotics. We suggest to restrict the administration of systemic antibiotic prophylaxis in orbital surgery.

  • antibiotics
  • orbital surgery
  • surgical site infections
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  • Contributors All authors substantially contributed to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafted the work or revised it critically for important intellectual content; and approved the final version published.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval was obtained from the scientific review board of the Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Individual participant data that underlie the results reported in this article, after deidentification. This is including the data of the excluded patients. Interested orbital surgeons can request the anonymised data by mail, when a methodologically sound proposal is provided and has been approved by our independent review committee. Proposals should be directed to To gain access, data requestors will need to sign a data access agreement.

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