Skip to main content

Advertisement

Log in

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

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection of anti-vascular endothelial growth factor (VEGF) medications.

Methods

In this retrospective case–control study, billing records and an infection log were used to identify all cases of endophthalmitis following intravitreal injection of ranibizumab, bevacizumab, or aflibercept between January 1, 2009 and September 30, 2013 at a single retina practice. A 28-month period when topical antibiotic drops were prescribed for use four times a day for 4 days following intravitreal injection was compared to a 21-month period when topical antibiotics were not prescribed. Patients treated during an 8-month transition period were excluded as prescription practices were changed.

Results

During the study period, a total of 172,096 anti-VEGF injections were performed. During the period when antibiotics were prescribed, 28 cases of suspected infectious endophthalmitis occurred from a total of 57,654 injections, ten of which were culture-positive. During the period when antibiotics were not used, 24 cases of suspected endophthalmitis occurred from a total of 89,825 injections, six of which were culture-positive. During the antibiotic period, four of the ten (40 %) culture-positive cases grew bacteria resistant to the prescribed prophylactic antibiotics. In contrast, none of the six culture-positive cases grew bacteria resistant to those antibiotics during the period when antibiotics were not used (odds ratio = 9.0; 95 % confidence interval = 0.40–203.3; p = 0.17).

Conclusions

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shah CP, Garg SJ, Vander JF, Brown GC, Kaiser RS, Haller JA, Post-Injection Endophthalmitis Study Team (2011) Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmology 118:2028–2034. doi:10.1016/j.ophtha.2011.02.034

    Article  PubMed  Google Scholar 

  2. McCannel CA (2011) Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina 31:654–661. doi:10.1097/IAE.0b013e31820a67e4

    PubMed  CAS  Google Scholar 

  3. Moss JM, Sanislo SR, Ta CN (2009) A prospective randomized evaluation of topical gatifloxacin on conjunctival flora in patients undergoing intravitreal injections. Ophthalmology 116:1498–1501. doi:10.1016/j.ophtha.2009.02.024

    Article  PubMed  Google Scholar 

  4. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S, Group AS (2006) Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 355:1432–1444. doi:10.1056/NEJMoa062655

    Article  PubMed  CAS  Google Scholar 

  5. Gragoudas ES, Adamis AP, Cunningham ET Jr, Feinsod M, Guyer DR, Group VISiONCT (2004) Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351:2805–2816. doi:10.1056/NEJMoa042760

    Article  PubMed  CAS  Google Scholar 

  6. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, Group MS (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431. doi:10.1056/NEJMoa054481

    Article  PubMed  CAS  Google Scholar 

  7. Storey P, Dollin M, Pitcher J, Reddy S, Vojtko J, Vander J, Hsu J, Garg SJ, Post-Injection Endophthalmitis Study Team (2014) The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection. Ophthalmology 121:283–289. doi:10.1016/j.ophtha.2013.08.037

    Article  PubMed  Google Scholar 

  8. Cheung CS, Wong AW, Lui A, Kertes PJ, Devenyi RG, Lam WC (2012) Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections. Ophthalmology 119:1609–1614. doi:10.1016/j.ophtha.2012.02.014

    Article  PubMed  Google Scholar 

  9. Bhavsar AR, Stockdale CR, Ferris FL 3rd, Brucker AJ, Bressler NM, Glassman AR, Diabetic Retinopathy Clinical Research N (2012) Update on risk of endophthalmitis after intravitreal drug injections and potential impact of elimination of topical antibiotics. Arch Ophthalmol 130:809–810. doi:10.1001/archophthalmol.2012.227

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kim SJ, Toma HS, Midha NK, Cherney EF, Recchia FM, Doherty TJ (2010) Antibiotic resistance of conjunctiva and nasopharynx evaluation study: a prospective study of patients undergoing intravitreal injections. Ophthalmology 117:2372–2378. doi:10.1016/j.ophtha.2010.03.034

    Article  PubMed  Google Scholar 

  11. Milder E, Vander J, Shah C, Garg S (2012) Changes in antibiotic resistance patterns of conjunctival flora due to repeated use of topical antibiotics after intravitreal injection. Ophthalmology 119:1420–1424. doi:10.1016/j.ophtha.2012.01.016

    Article  PubMed  Google Scholar 

  12. Pagano M, Gauvreau K (2000) Principles of biostatistics. Duxbury Press, Pacific Grove

    Google Scholar 

  13. Deeks JJ, Higgins JP (2010) Statistical algorithms in Review Manager 5. Statistical Methods Group of The Cochrane Collaboration: 1–11

  14. Hariprasad SM, Blinder KJ, Shah GK, Apte RS, Rosenblatt B, Holekamp NM, Thomas MA, Mieler WF, Chi J, Prince RA (2005) Penetration pharmacokinetics of topically administered 0.5 % moxifloxacin ophthalmic solution in human aqueous and vitreous. Arch Ophthalmol 123:39–44. doi:10.1001/archopht.123.1.39

    Article  PubMed  CAS  Google Scholar 

  15. Bhatt SS, Stepien KE, Joshi K (2011) Prophylactic antibiotic use after intravitreal injection: effect on endophthalmitis rate. Retina 31:2032–2036. doi:10.1097/IAE.0b013e31820f4b4f

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Martinez JL, Baquero F (2000) Mutation frequencies and antibiotic resistance. Antimicrob Agents Chemother 44:1771–1777

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Mamber SW, Kolek B, Brookshire KW, Bonner DP, Fung-Tomc J (1993) Activity of quinolones in the Ames Salmonella TA102 mutagenicity test and other bacterial genotoxicity assays. Antimicrob Agents Chemother 37:213–217

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Ysern P, Clerch B, Castano M, Gibert I, Barbe J, Llagostera M (1990) Induction of SOS genes in Escherichia coli and mutagenesis in Salmonella typhimurium by fluoroquinolones. Mutagenesis 5:63–66

    Article  PubMed  CAS  Google Scholar 

  19. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T, Group AS (2009) Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: Two-year results of the ANCHOR study. Ophthalmology 116(57–65), e55. doi:10.1016/j.ophtha.2008.10.018

    Google Scholar 

  20. Mino de Kaspar H, Koss MJ, He L, Blumenkranz MS, Ta CN (2005) Antibiotic susceptibility of preoperative normal conjunctival bacteria. Am J Ophthalmol 139:730–733. doi:10.1016/j.ajo.2004.10.007

    Article  PubMed  CAS  Google Scholar 

  21. Ta CN, Chang RT, Singh K, Egbert PR, Shriver EM, Blumenkranz MS, Mino de Kaspar H (2003) Antibiotic resistance patterns of ocular bacterial flora: a prospective study of patients undergoing anterior segment surgery. Ophthalmology 110:1946–1951

    Article  PubMed  Google Scholar 

  22. Hooper DC (2002) Fluoroquinolone resistance among Gram-positive cocci. Lancet Infect Dis 2:530–538

    Article  PubMed  CAS  Google Scholar 

  23. Mino De Kaspar H, Hoepfner AS, Engelbert M, Thiel M, Ta CN, Mette M, Schulze-Schwering M, Grasbon T, Sesma-Vea B, Casas JM, Iturralde-Goni R, Klauss V, Kampik A (2001) Antibiotic resistance pattern and visual outcome in experimentally-induced Staphylococcus epidermidis endophthalmitis in a rabbit model. Ophthalmology 108:470–478

    Article  PubMed  CAS  Google Scholar 

  24. Wen JC, McCannel CA, Mochon AB, Garner OB (2011) Bacterial dispersal associated with speech in the setting of intravitreous injections. Arch Ophthalmol 129:1551–1554. doi:10.1001/archophthalmol.2011.227

    Article  PubMed  Google Scholar 

  25. Abell RG, Kerr NM, Allen P, Vote BJ (2012) Intravitreal injections: is there benefit for a theatre setting? Br J Ophthalmol 96:1474–1478. doi:10.1136/bjophthalmol-2012-302030

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding authors

Correspondence to Philip Storey or Sunir Garg.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Storey, P., Dollin, M., Rayess, N. et al. The effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection. Graefes Arch Clin Exp Ophthalmol 254, 235–242 (2016). https://doi.org/10.1007/s00417-015-3035-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-015-3035-x

Keywords

Navigation