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Charles Calvo, Nadim Rayess, Ehsan Rahimy, Chirag Shah, Jeremy D Wolfe, Eric Chen, Francis DeCroos, Sunir J Garg, Jason Hsu; Microbiologic spectrum of post-injection endophthalmitis by indication for intravitreal anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4070.
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To describe the microbiologic spectrum of endophthalmitis following intravitreal anti-VEGF injections for treatment of neovascular age-related macular degeneration (AMD), diabetic eye disease, and retinal vein occlusion (RVO).
A multicenter, retrospective, consecutive case series.
Between January 1, 2011 and September 30, 2013, a total of 503,890 intravitreal anti-VEGF injections were performed at the five participating clinical sites. Presumed infectious endophthalmitis occurred in 159 of 416,133 injections performed for neovascular AMD (1/2617), 16 of 40,982 for diabetic eye disease (1/2561), and 8 of 46,775 for RVO (1/5846). For patients with neovascular AMD, 61 of the 159 cases (38%) of endophthalmitis were culture positive, corresponding to a culture positive rate of 1/6822. The cultured organisms included 13 cases of coagulase-negative Staphylococcus, 12 of S. epidermidis, 5 of S. pneumonia, 5 of S. mitis, 5 of methicillin-sensitive S. aureus, 4 of Staphylococcus lugdunesis, 4 of Enterococcus fecalis, 3 of S. viridans, 3 of non-differentiated gram-positive cocci, and 1 case of each of the following organisms: Staphylococcus auricularis, Staphylococcus homininis, Streptococcus sanguis, alpha-hemolytic Streptococcus, Candida parapsicolosis, Propionibacterium, and Lactobacillus. For patients treated for diabetic eye disease, 8 of the 16 cases (50%) were culture positive, providing a culture positive rate of 1/5123. Four eyes grew coagulase-negative Staphylococcus, 2 had S. epidermidis, and there was 1 case of S. pneumonia and 1 case of H. influenzae. For patients with RVO, 4 of the 8 cases (50%) were culture positive, resulting in an overall culture positive rate of 1/11,694. There was 1 case of S. pneumoniae, methicillin-sensitive S. aureus, S. mitis, and coagulase-negative Staphylococcus.
Gram-positive coagulase-negative Staphylococcus was the most common bacteria isolated in cases of post-injection endophthalmitis. A greater proportion of coagulase-negative Staphylococcus was found in endophthalmitis following injections for diabetic eye disease (75%) compared to AMD (51%) and RVO (25%). Oral flora pathogens accounted for 22% of the cases.
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