Bacterial Resistance in Patients Receiving Post-Intravitreal Injection Antibiotics
Sponsored by Loma Linda University
1. Background: Over 1 million intravitreal injections are performed annually in the United
States. The most devastating complication related to these injections is
endophthalmitis, with an incidence of 0.02 - 0.1% per injection. Techniques aimed at
prevention of this complication have been studied, though emergence rates of antibiotic
resistant bacteria in a single clinic population comparing antiseptic technique with
iodine vs. use of post-injection second generation fluoroquinolones has not been
reported in the literature.
2. Objectives: The purpose of the study is to help determine the best way to prevent
infection and limit antibiotic resistance in patients receiving eye injections.
3. Procedures Involved (Research Interventions): After the patient is chosen based on
inclusion criteria and agrees to participate in the study, exclusion criteria will be
reviewed, cognizance will be determined, informed consent and HIPAA compliance forms
will be signed. At this point and prior to the instillation of ophthalmic medications,
a Rayon swab will be passed along the inferior fornix of the study eye while the
patient looks up and the examiner lowers the lower eyelid. The swab will then be used
to inoculate chocolate agar and a blood agar culture plates and a glass slide. These
will be brought to the FMO microbiology department for culture and Gram stain. All
Staphylococcus aureus and coagulase negative Staphylococcus species identified will be
subjected to sensitivity testing using the Gram Positive antibiotic panel available at
Loma Linda, with the addition of ciprofloxacin.
Patients with choroidal neovascularization due to wet age-related macular degeneration or any other cause, clinically significant macular edema or cystoid macular edema over age 18 who have been treated with at least 3 monthly intravitreal injections of an anti-Vascular Endothelial Growth Factor (anti-VEGF) agent in the last 6 months. These injections must have been given in either Dr. Fan's clinic using povidone-iodine and post-injection topical ciprofloxacin 0.3% 4x daily for 3 days, or in Dr. Rauser's clinic where povidone-iodine only is applied to the injection site and conjunctival fornix but no post-injection antibiotics are given
Administration of anti-VEGF agents outside of Dr. Fan's or Dr. Rauser's clinics
Use of topical antibiotics other than ciprofloxacin 0.3%
Infections of the eye or ocular adnexa within the last 3 months
Use of oral antibiotics within the last 30 days
Contact lens wear
Study Locations And Contact Information
Loma Linda University of Health Sciences Faculty Medical Offices, Loma Linda California
Contact: David I Sierpina MD 815-319-0527 firstname.lastname@example.org
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