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Article: Antibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection

TitleAntibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection
Authors
Issue Date2013
Citation
JAMA Ophthalmology, 2013, v. 131, n. 4, p. 456-461 How to Cite?
AbstractImportance: Treatment with intravitreal (IVT) injections has increased during the last several years as evidence has accumulated demonstrating the efficacy of anti-vascular endothelial growth factor agents in the treatment of neovascular age-related macular degeneration (AMD) and various retinal vascular diseases. Although IVT injections are generally safe, infectious endophthalmitis is a rare but devastating complication, and the risk of morbidity and vision loss from endophthalmitis is high. Objective: To examine the change in antibiotic resistance of ocular surface flora with repeated prophylactic use of antibiotics after IVT injection for AMD. Design and Setting: Prospective, nonrandomized cohort study in 2 tertiary academic hospitals. Participants: Patients 65 years and older with newly diagnosedAMDwere recruited by 7 retinal specialists from July 1, 2010, through December 31, 2011. Intervention: The study group received topical moxifloxacin hydrochloride for 3 days after each monthly IVT injection. Main Outcome Measure: Resistance to moxifloxacin and ceftazidime in cultured isolates at baseline and monthly for 3 months by change in minimal inhibitory concentration (MIC) of culture isolates was studied. Results: The study group consisted of 84 patients, and the control group had94patients. In the study group, the baseline adjusted MIC increased (from 1.04 to 1.25 >g/mL; P=.01) as did the MIC for 50% of isolates (MIC50) (from 0.64 to 1.00>g/mL)andtheMICfor90%of isolates(MIC90) (from 0.94 to 4.00 >g/mL). In both groups, the culturepositive rate did not change significantlywhenadjusted for baseline.Nosignificant change was found in theMIClevel, culture-positive rate,MIC50 level,andMIC90 level in thecontrol group. Subgroup analysis found diabetes mellitus to be noncontributory to both theMICand culture-positive rate. No endophthalmitis or adverse events were reported. Conclusions and Relevance: Repeated use of topical moxifloxacin after IVT injection significantly increases antibiotic resistance of ocular surface flora. We recommend that routine use of prophylactic antibiotics after IVT injection be discouraged. Copyright © 2013 American Medical Association. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/228154
ISSN
2015 Impact Factor: 4.34
2015 SCImago Journal Rankings: 1.879

 

DC FieldValueLanguage
dc.contributor.authorYin, Vivian T.-
dc.contributor.authorWeisbrod, Daniel J.-
dc.contributor.authorEng, Kenneth T.-
dc.contributor.authorSchwartz, Carol-
dc.contributor.authorKohly, Radha-
dc.contributor.authorMandelcorn, Efrem-
dc.contributor.authorLam, Wai Ching-
dc.contributor.authorDaneman, Nick-
dc.contributor.authorSimor, Andrew-
dc.contributor.authorKertes, Peter J.-
dc.date.accessioned2016-08-01T06:45:19Z-
dc.date.available2016-08-01T06:45:19Z-
dc.date.issued2013-
dc.identifier.citationJAMA Ophthalmology, 2013, v. 131, n. 4, p. 456-461-
dc.identifier.issn2168-6165-
dc.identifier.urihttp://hdl.handle.net/10722/228154-
dc.description.abstractImportance: Treatment with intravitreal (IVT) injections has increased during the last several years as evidence has accumulated demonstrating the efficacy of anti-vascular endothelial growth factor agents in the treatment of neovascular age-related macular degeneration (AMD) and various retinal vascular diseases. Although IVT injections are generally safe, infectious endophthalmitis is a rare but devastating complication, and the risk of morbidity and vision loss from endophthalmitis is high. Objective: To examine the change in antibiotic resistance of ocular surface flora with repeated prophylactic use of antibiotics after IVT injection for AMD. Design and Setting: Prospective, nonrandomized cohort study in 2 tertiary academic hospitals. Participants: Patients 65 years and older with newly diagnosedAMDwere recruited by 7 retinal specialists from July 1, 2010, through December 31, 2011. Intervention: The study group received topical moxifloxacin hydrochloride for 3 days after each monthly IVT injection. Main Outcome Measure: Resistance to moxifloxacin and ceftazidime in cultured isolates at baseline and monthly for 3 months by change in minimal inhibitory concentration (MIC) of culture isolates was studied. Results: The study group consisted of 84 patients, and the control group had94patients. In the study group, the baseline adjusted MIC increased (from 1.04 to 1.25 >g/mL; P=.01) as did the MIC for 50% of isolates (MIC50) (from 0.64 to 1.00>g/mL)andtheMICfor90%of isolates(MIC90) (from 0.94 to 4.00 >g/mL). In both groups, the culturepositive rate did not change significantlywhenadjusted for baseline.Nosignificant change was found in theMIClevel, culture-positive rate,MIC50 level,andMIC90 level in thecontrol group. Subgroup analysis found diabetes mellitus to be noncontributory to both theMICand culture-positive rate. No endophthalmitis or adverse events were reported. Conclusions and Relevance: Repeated use of topical moxifloxacin after IVT injection significantly increases antibiotic resistance of ocular surface flora. We recommend that routine use of prophylactic antibiotics after IVT injection be discouraged. Copyright © 2013 American Medical Association. All rights reserved.-
dc.languageeng-
dc.relation.ispartofJAMA Ophthalmology-
dc.titleAntibiotic resistance of ocular surface flora with repeated use of a topical antibiotic after intravitreal injection-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1001/jamaophthalmol.2013.2379-
dc.identifier.pmid23430175-
dc.identifier.scopuseid_2-s2.0-84876257480-
dc.identifier.volume131-
dc.identifier.issue4-
dc.identifier.spage456-
dc.identifier.epage461-

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