Endophthalmitis prophylaxis by intracameral antibiotics: In vitro model comparing vancomycin, cefuroxime, and moxifloxacin
| Autor: | Sean Mathews, Peter E. Libre |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.drug_class
Moxifloxacin Antibiotics Eye Infections Bacterial Microbiology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Endophthalmitis Lens Implantation Intraocular Vancomycin medicine Humans Antibiotic prophylaxis Lenses Intraocular Cefuroxime biology business.industry Antibiotic Prophylaxis Eye infection medicine.disease biology.organism_classification Sensory Systems Anti-Bacterial Agents Ophthalmology Anesthesia 030221 ophthalmology & optometry Surgery business 030217 neurology & neurosurgery Bacteria medicine.drug |
| Zdroj: | Journal of Cataract and Refractive Surgery. 43:833-838 |
| ISSN: | 0886-3350 |
| DOI: | 10.1016/j.jcrs.2017.04.028 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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