Resistance to Antibiotics in Patients Receiving Eye Injections
| Status: | Completed |
|---|---|
| Conditions: | Ocular, Diabetes |
| Therapuetic Areas: | Endocrinology, Ophthalmology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 6/2/2016 |
| Start Date: | May 2014 |
| End Date: | September 2014 |
Prospective Study on Antimicrobial Resistance Rates Following Repeated Courses of Topical Antibiotics for Intravitreal Injection
The administration of short courses of topical antibiotic drops before and/or after
intravitreal injections is a common practice, but increasing evidence suggests this may not
lower the risk of infectious endophthalmitis and could increase rates of antimicrobial
resistance. The purpose of the present study is to determine the antimicrobial resistance
profiles in patients who have received numerous (≥ 20) courses of antibiotics for
intravitreal injection compared with untreated controls.
This study compares 20 control patients without prior intravitreal injection to 20 patients
who have undergone ≥ 20 prior intravitreal injections accompanied by a course of topical
antibiotics for two days before and/or after the injection procedure. The lower, inner
eyelid and nasal cavity were cultured and evaluated via disk diffusion method for
antimicrobial sensitivity.
intravitreal injections is a common practice, but increasing evidence suggests this may not
lower the risk of infectious endophthalmitis and could increase rates of antimicrobial
resistance. The purpose of the present study is to determine the antimicrobial resistance
profiles in patients who have received numerous (≥ 20) courses of antibiotics for
intravitreal injection compared with untreated controls.
This study compares 20 control patients without prior intravitreal injection to 20 patients
who have undergone ≥ 20 prior intravitreal injections accompanied by a course of topical
antibiotics for two days before and/or after the injection procedure. The lower, inner
eyelid and nasal cavity were cultured and evaluated via disk diffusion method for
antimicrobial sensitivity.
Before administration of anti-VEGF therapy (Vascular Endothelial Growth Factor) or topical
antibiotics, conjunctival and nasopharyngeal swabs are procured with the Bacti-Swab
transport system (Thermo Fisher Scientific, Waltham, MA). For conjunctival samples, a
sterile swab is moistened with ophthalmic balanced salt solution and gently swept along the
lower fornix from the medial to the lateral canthi, with all attempts to avoid the eyelashes
and eyelids. For nasopharyngeal cultures, the sterile swab is inserted 2 cm into the naris
and rotated against the anterior nasal mucosa for 3 seconds.
Culture swabs are then plated onto 5% sheep blood plates and incubated at 37°C for 3 days.
Colonies are isolated and identified with API (Analytical Profile Index) Microbial
Identification Kits (bioMérieux Inc., Hazelwood, MO). Antibiotic susceptibility is
determined using the Kirby Bauer disc diffusion method. Additional data collected includes
age, ocular and systemic medical conditions, and the number of intravitreal injections along
with anti-VEGF agents used.
Statistical calculations for antibiotic resistance comprises of t-test and and multivariate
analysis.
antibiotics, conjunctival and nasopharyngeal swabs are procured with the Bacti-Swab
transport system (Thermo Fisher Scientific, Waltham, MA). For conjunctival samples, a
sterile swab is moistened with ophthalmic balanced salt solution and gently swept along the
lower fornix from the medial to the lateral canthi, with all attempts to avoid the eyelashes
and eyelids. For nasopharyngeal cultures, the sterile swab is inserted 2 cm into the naris
and rotated against the anterior nasal mucosa for 3 seconds.
Culture swabs are then plated onto 5% sheep blood plates and incubated at 37°C for 3 days.
Colonies are isolated and identified with API (Analytical Profile Index) Microbial
Identification Kits (bioMérieux Inc., Hazelwood, MO). Antibiotic susceptibility is
determined using the Kirby Bauer disc diffusion method. Additional data collected includes
age, ocular and systemic medical conditions, and the number of intravitreal injections along
with anti-VEGF agents used.
Statistical calculations for antibiotic resistance comprises of t-test and and multivariate
analysis.
Inclusion Criteria:
- Adult patients (above age 18) diagnosed with age-related macular degeneration and
receiving their 1st or 20th (or >20th) intravitreal injection therapy.
Exclusion Criteria:
- Those with current use of topical or systemic antibiotics and an active ocular
infection or ocular surface disease.
We found this trial at
1
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