Peter E Libre1, Sean Mathews2. 1. From Harkness Eye Institute (Libre), Columbia University Medical Center, New York, New York, and Norwalk Hospital (Libre), Norwalk, and the University of Connecticut (Mathews), Storrs, Connecticut, USA. Electronic address: pel3@cumc.columbia.edu. 2. From Harkness Eye Institute (Libre), Columbia University Medical Center, New York, New York, and Norwalk Hospital (Libre), Norwalk, and the University of Connecticut (Mathews), Storrs, Connecticut, USA.
Abstract
PURPOSE: To compare the efficacy of intracameral vancomycin, cefuroxime, and moxifloxacin on postoperative bacterial endophthalmitis rates. SETTING: Norwalk Hospital, Norwalk, Connecticut, USA. DESIGN: Experimental study. METHODS: Bacteria and intraocular lenses (IOLs) were incubated with vancomycin, cefuroxime, moxifloxacin, or combinations. Antibiotic concentrations were high, corresponding to clinical maximum intracameral doses (1.0 mg vancomycin or cefuroxime, 0.5 mg moxifloxacin), or low (one third of clinical maximum dose). The following bacteria were isolated from patients with endophthalmitis: 18 strains including 6 staphylococci, 6 streptococci, 3 pseudomonad, and 3 propionibacteria. Samples were diluted by half every 2 hours to model the half-life of intracameral antibiotics. At 24 hours, samples were vortexed to shake bacterial biofilms loose from the IOLs. The bacterial broth was plated and colonies were counted 24 hours later. RESULTS: Efficacy against staphylococci was concentration dependent; all antibiotics were effective at high concentrations, while low concentrations were in general ineffective. Streptococci and propionibacteria were nearly eliminated by all antibiotics at low concentrations. Pseudomonads were most effectively treated by high-dose moxifloxacin and its combinations. CONCLUSIONS: Broadest coverage against common pathogens should be obtained by high-dose moxifloxacin (0.5 mg intracameral). Submaximum dosing, which could occur if aqueous is released to lower intraocular pressure after injection, compromises the efficacy against staphylococci and pseudomonads. All antibiotics, even at low doses, were effective against streptococci and propionibacteria, suggesting that many of the worst endophthalmitis outcomes could be prevented by intracameral use of any of the 3 antibiotics used in this study.
PURPOSE: To compare the efficacy of intracameral vancomycin, cefuroxime, and moxifloxacin on postoperative bacterial endophthalmitis rates. SETTING: Norwalk Hospital, Norwalk, Connecticut, USA. DESIGN: Experimental study. METHODS: Bacteria and intraocular lenses (IOLs) were incubated with vancomycin, cefuroxime, moxifloxacin, or combinations. Antibiotic concentrations were high, corresponding to clinical maximum intracameral doses (1.0 mg vancomycin or cefuroxime, 0.5 mg moxifloxacin), or low (one third of clinical maximum dose). The following bacteria were isolated from patients with endophthalmitis: 18 strains including 6 staphylococci, 6 streptococci, 3 pseudomonad, and 3 propionibacteria. Samples were diluted by half every 2 hours to model the half-life of intracameral antibiotics. At 24 hours, samples were vortexed to shake bacterial biofilms loose from the IOLs. The bacterial broth was plated and colonies were counted 24 hours later. RESULTS: Efficacy against staphylococci was concentration dependent; all antibiotics were effective at high concentrations, while low concentrations were in general ineffective. Streptococci and propionibacteria were nearly eliminated by all antibiotics at low concentrations. Pseudomonads were most effectively treated by high-dose moxifloxacin and its combinations. CONCLUSIONS: Broadest coverage against common pathogens should be obtained by high-dose moxifloxacin (0.5 mg intracameral). Submaximum dosing, which could occur if aqueous is released to lower intraocular pressure after injection, compromises the efficacy against staphylococci and pseudomonads. All antibiotics, even at low doses, were effective against streptococci and propionibacteria, suggesting that many of the worst endophthalmitis outcomes could be prevented by intracameral use of any of the 3 antibiotics used in this study.
Authors: Sonia Bianchini; Chiara Morini; Laura Nicoletti; Sara Monaco; Erika Rigotti; Caterina Caminiti; Giorgio Conti; Maia De Luca; Daniele Donà; Giuseppe Maglietta; Laura Lancella; Andrea Lo Vecchio; Giorgio Marchini; Carlo Pietrasanta; Nicola Principi; Alessandro Simonini; Elisabetta Venturini; Rosa Longo; Elena Gusson; Domenico Boccuzzi; Luca Vigo; Fabio Mosca; Annamaria Staiano; Susanna Esposito Journal: Antibiotics (Basel) Date: 2022-04-22