OBJECTIVE: To determine the effect of repeated intermittent use of topical antibiotics after intravitreal injections on conjunctival bacterial flora and antibiotic resistance. DESIGN: Cross-sectional case-control study. PARTICIPANTS AND CONTROLS: A total of 80 eyes of 40 patients were enrolled (40 study eyes, 40 control eyes). Patients were enrolled with unilateral exudative age-related macular degeneration who had received at least 3 prior intravitreal injections with use of postinjection topical antibiotics. Patients had received an average of 7 (range, 3-13) intravitreal injections before enrollment. METHODS: At the time of enrollment, the inferior fornix of the treated eye was swept with a culture swab before use of povidone iodine; the inferior fornix of the fellow eye was also cultured and served as a control. The culture and sensitivity data from the study and control eyes were analyzed. MAIN OUTCOME MEASURES: The rate of antibiotic resistance among the conjunctival bacterial flora of the study eyes and control eyes. RESULTS: A total of 80 eyes of 40 patients were enrolled in the study; 29 patients used trimethoprim/polymyxin B drops, and 11 patients used fluoroquinolone drops after each injection. A total of 58 bacterial colonies were isolated from 50 eyes. There were no significant differences in bacterial species or culture positivity rates between study and control eyes. Coagulase-negative staphylococcus accounted for 41 of the 58 bacterial colonies (71%). There was a 63.6% resistance rate to fluoroquinolones among study eyes compared with 32.1% among control eyes (P < 0.05). In the subset of 11 study eyes using fluoroquinolone drops for 4 days after injection, there was an 87.5% resistance rate compared with 25.0% in matched control eyes (P = 0.04). There was no significant difference in trimethoprim resistance rates between study and control eyes: Four of 14 study eyes (28.6%) showed resistance compared with 5 of 18 control eyes (27.7%) (P = 1.0). CONCLUSIONS: Use of fluoroquinolone drops after intravitreal injection leads to increased rates of resistance among conjunctival flora. Repeated use of topical fluoroquinolones after intravitreal injections may have a detrimental effect on eye health by breeding resistance in the bacterial flora.
OBJECTIVE: To determine the effect of repeated intermittent use of topical antibiotics after intravitreal injections on conjunctival bacterial flora and antibiotic resistance. DESIGN: Cross-sectional case-control study. PARTICIPANTS AND CONTROLS: A total of 80 eyes of 40 patients were enrolled (40 study eyes, 40 control eyes). Patients were enrolled with unilateral exudative age-related macular degeneration who had received at least 3 prior intravitreal injections with use of postinjection topical antibiotics. Patients had received an average of 7 (range, 3-13) intravitreal injections before enrollment. METHODS: At the time of enrollment, the inferior fornix of the treated eye was swept with a culture swab before use of povidone iodine; the inferior fornix of the fellow eye was also cultured and served as a control. The culture and sensitivity data from the study and control eyes were analyzed. MAIN OUTCOME MEASURES: The rate of antibiotic resistance among the conjunctival bacterial flora of the study eyes and control eyes. RESULTS: A total of 80 eyes of 40 patients were enrolled in the study; 29 patients used trimethoprim/polymyxin B drops, and 11 patients used fluoroquinolone drops after each injection. A total of 58 bacterial colonies were isolated from 50 eyes. There were no significant differences in bacterial species or culture positivity rates between study and control eyes. Coagulase-negative staphylococcus accounted for 41 of the 58 bacterial colonies (71%). There was a 63.6% resistance rate to fluoroquinolones among study eyes compared with 32.1% among control eyes (P < 0.05). In the subset of 11 study eyes using fluoroquinolone drops for 4 days after injection, there was an 87.5% resistance rate compared with 25.0% in matched control eyes (P = 0.04). There was no significant difference in trimethoprim resistance rates between study and control eyes: Four of 14 study eyes (28.6%) showed resistance compared with 5 of 18 control eyes (27.7%) (P = 1.0). CONCLUSIONS: Use of fluoroquinolone drops after intravitreal injection leads to increased rates of resistance among conjunctival flora. Repeated use of topical fluoroquinolones after intravitreal injections may have a detrimental effect on eye health by breeding resistance in the bacterial flora.
Authors: Geraldine R Slean; Neal H Shorstein; Liyan Liu; John F Paschal; Kevin L Winthrop; Lisa J Herrinton Journal: Clin Exp Ophthalmol Date: 2017-01-31 Impact factor: 4.207
Authors: Travis A Meredith; Colin A McCannel; Charles Barr; Bernard H Doft; Ellen Peskin; Maureen G Maguire; Daniel F Martin; Jonathan L Prenner Journal: Ophthalmology Date: 2015-01-15 Impact factor: 12.079
Authors: Catherine E Oldenburg; Prajna Lalitha; Muthiah Srinivasan; Revathi Rajaraman; Meenakshi Ravindran; Jeena Mascarenhas; Durga S Borkar; Kathryn J Ray; Michael E Zegans; Stephen D McLeod; Travis C Porco; Thomas M Lietman; Nisha R Acharya Journal: Ophthalmic Epidemiol Date: 2013-05-10 Impact factor: 1.648