The effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection

Storey, Philip; Dollin, Michael; Rayess, Nadim; Pitcher, John D.; Reddy, Sahitya; Vander, J.F.; Hsu, Jason; Garg, Sunir J.

doi:10.1007/s00417-015-3035-x

Cited by 57 publications

(42 citation statements)

References 24 publications

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“…Repeated intravitreal injections with the use of prophylactic postinjection antibiotics increase the risk of drug resistance. [10] Aerosolized droplet contamination from the oropharyngeal tract may occur leading to streptococcal infection. This can be minimized by wearing a sterile mask and avoiding talking or coughing during the procedure.…”

Section: Discussionmentioning

confidence: 99%

Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant

Mahalingam¹,

Topiwalla²,

Ganesan³

2017

Indian J Ophthalmol

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A 60-year-old female came to our hospital with defective vision due to persistent diabetic macular edema and was treated with intravitreal ozurdex implant in the right eye. Three days later, the patient presented with diminution of vision, ocular pain, congestion, and hypopyon with no fundus view. B-scan ultrasonography showed vitritis, and diagnosis of endophthalmitis was made. Subsequently, 25-gauge pars plana vitrectomy was performed along with intravitreal vancomycin and amikacin and removal of implant. On culture, there was growth of coagulase-negative staphylococcus which was resistant to ofloxacin antibiotic. A week following treatment, there was significant improvement in the patient's sign and symptoms with improvement in vision. Our case demonstrated that acute endophthalmitis can occur following dexamethasone intravitreal implant.

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Section: Discussionmentioning

confidence: 99%

Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant

Mahalingam¹,

Topiwalla²,

Ganesan³

2017

Indian J Ophthalmol

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“…The same authors also noted that only antibiotic-resistant strains of Staphylococcus epidermidis have been isolated from their patients with postoperative endophthalmitis. The PIE study team examined two study periods: an initial period during which topical antibiotics were prescribed for 4 days following injection and a second period when antibiotics were not prescribed (Storey et al 2016). The PIE study team examined two study periods: an initial period during which topical antibiotics were prescribed for 4 days following injection and a second period when antibiotics were not prescribed (Storey et al 2016).…”

Section: Antibiotic Resistancementioning

confidence: 99%

Topical antibiotics and intravitreal injections

Hunyor

Merani

Darbar

et al. 2017

Acta Ophthalmologica

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There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.

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“…19 Lastly, early and accurate diagnosis of postinjection endophthalmitis is important as timely intervention will make a difference in the outcome. [20][21][22][23] Table 3 shows some of the differentiating features among true, sterile, and pseudo endophthalmitis. [30][31][32][33][34][35][36][37][38] SUMMARY Many clinics and hospitals are now being overwhelmed by a large volume of patients requiring IVT injection.…”

Section: Needle Gauge and Lengthmentioning

confidence: 99%

Intravitreal Injection—Technique and Safety

Lai¹,

Liu

Das

et al. 2015

Asia-Pacific Journal of Ophthalmology

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Intravitreal (IVT) injection of therapeutic agents has become one of the most commonly performed procedures in ophthalmology. Over the past decade, a number of guidelines have been published that recommend proper techniques to increase the safety of IVT injections. Among the various complications of IVT injections, endophthalmitis can be sight threatening. The reported endophthalmitis rates after IVT injection range from 0.020% to 0.085%, which are higher than what would be expected from a simple, fast, and relatively atraumatic procedure. The 2 key issues involved in the prevention of endophthalmitis are pre-IVT injection disinfection using povidone-iodine (PVI) and the use of topical antibiotics as prophylaxis. Whereas 5% PVI for 5 minutes is most commonly used in cataract surgery for disinfection, the duration in IVT injection is much less and can be as short as 30 seconds. Further studies seem warranted to investigate whether longer duration of PVI application in IVT injection can lower the endophthalmitis rate. Recent data suggest that there is inadequate evidence to support the routine use of prophylactic pre-, peri-, or postinjection antibiotics to reduce the risk of endophthalmitis. However, as many confounding factors such as the PVI regimens were not standardized in previous studies, it is too soon to make a concrete conclusion. Despite the availability of published guidelines, considerable variations still exist in real-life clinical situations. In this article, we describe our IVT injection practice protocol and compare it with the most recent international guidelines. Finally, a summary table that shows the clinical features of true, sterile, and pseudoendophthalmitis is presented.

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The effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection

Abstract: The use of prophylactic topical antibiotics following intravitreal injection may lead to higher rates of antibiotic-resistant bacteria in culture-positive endophthalmitis cases.

Cited by 57 publications

References 24 publications

Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant

Drug-resistant coagulase-negative staphylococcal endophthalmitis following dexamethasone intravitreal implant

Topical antibiotics and intravitreal injections

Intravitreal Injection—Technique and Safety

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