Impact of Antibiotic Prophylaxis on the Conjunctival Flora of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor Injections

Abstract

Purpose: To characterize the conjunctival flora of patients receiving antibiotics before intravitreal (IVT) antivascular endothelial growth factor injections. Methods: We studied 31 eyes of 30 patients with neovascular age-related macular degeneration scheduled to receive IVT antivascular endothelial growth factor injections. The patients were all given a preinjection of topical ofloxacin 3 days before the injections. Conjunctival cultures from the injection eye were collected before antibiotic prophylaxis (sample A) and on the injection day, both before (sample B) and after (sample C) povidone-iodine (PVI) application. Results: Culture positivity was significantly different between samples A (50%) and C (4.5%; p < 0.001) as well as samples B (30.4%) and C (4.5%; p = 0.015), but not between samples A and B. Positive cultures were mainly coagulase-negative staphylococci (CNS; 57% of sample A, 62.5% of sample B and 100% of sample C) susceptible to vancomycin (100%), moxifloxacin (90%), levofloxacin (70%) and ofloxacin (60%). Conclusion: In our study, most of the bacteria isolated were CNS. PVI application but not antibiotics reduced culture positivity.

Outcome of intravitreal bevacizumab injection without pre and postoperative antibiotics

“…Antibiotic prophylaxis with ofloxacin did not reduce the number of positive cultures as opposed to PVI application. [2] The results of a large meta-analysis study by MF Bande et al established that the prophylactic use of antibiotics for intravitreal anti-VEGF injections is associated with a higher incidence of endophthalmitis. This finding could potentially eliminate an unnecessary intervention that is likely harmful to patients.…”

Outcome of intravitreal bevacizumab injection without pre and postoperative antibiotics

“…Intravitreal injections are the most common treatment modality for several retinal pathologies [2]. Repeated doses for longer duration are often required for patients receiving anti-Vascular Endothelial Growth Factor (VEGF) injection therapy for retinal disease.…”