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Enoch Kassa, Jonathan Gambrell, Yang Sun, Charles Barr; Conjunctival Bacterial Resistance Patterns to Antibiotics for Intravitreal Injection: Effects of Maxitrol and Betadine in Clinical Practice. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):286.
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To determine if intravitreal injections are conducted in a properly sterilized environment. Endophthalmitis is the most feared complication of intravitreal injections. Conventionally, anti-septics without antibiotics are used to sterilize the conjunctival surface before injections. This study investigates the effect of Maxitrol (neomycin and polymyxin B sulfates and dexamethasone ophthalmic suspension) on bacterial isolates when used in addition to betadine 5%.
This is a randomized prospective study from 2011-2012 at the University of Louisville School of Medicine Department of Ophthalmology. Eighty-six patients requiring intravitreal injections were enrolled in the study, with 110 eyes randomized into 55 control sample and 55 treatment sample. A swab culture was obtained on all eyes before any anti-bacterial or anti-septic application. A second swab culture was obtained post application of the sterilizing agents and/or antibiotic. Sensitivities were obtained and the cultures from each group were counted and compared. Statistical analysis was performed using SASS.
Conjunctival swab cultures were initially obtained from 110 eyes. 50 swabs from untreated eyes grew bacteria (n=110, 45%). 55 eyes were then treated with betadine 5% and the other 55 eyes were treated with a combination of Maxitrol and Betadine 5%. 20 swabs from eyes treated without Maxitrol grew bacteria while 8 swabs treated with Maxitrol grew bacteria (n=110, p-value=0.0084). The most common bacteria isolated was coagulase negative staphylococcus (CNS) (63 %). 15 (75%) swabs from eyes treated without Maxitrol grew CNS while 4 (50%) swabs from Maxitrol treated eyes grew CNS (n=110, p-value=0.0098).
Significant reduction in endophthalmitis causing organisms were observed in the group treated with both Maxitrol and betadine. In patients receiving intravitreal injections, preparing the injection site with a combination of betadine and Maxitrol may reduce the incidence of inadvertent infectious complications.
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