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Vivian T. Yin, Daniel Weisbrod, Efrem Mandelcorn, Carol Schwartz, Radha Kohly, Ken Eng, Wai-Ching Lam, Peter Kertes; Increased Antibiotic Resistance Of Ocular Surface Flora After Repeated Use Of Prophylactic Topical Fluoroquinolone Post Intravitreal Injection For Neovascular Age-related Macular Degeneration (amd). Invest. Ophthalmol. Vis. Sci. 2012;53(14):6269.
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To determine if repeated use of prophylactic topical fluoroquinolone post monthly intravitreal injections for AMD will change the antibiotic resistance profile of the ocular surface flora over time.
This was a prospective, multicenter, case-control study of patients 65 years and older with neovascular AMD undergoing treatment with monthly intravitreal injections of ranibizumab. Patients were excluded if they had active ocular or systemic infection, previously received intravitreal injections or were treated with topical or systemic antibiotics in the past three months. Patients were divided into two groups, those that received topical moxifloxacin for 3 days post injection (antibiotic group) and those that did not (no antibiotic group). Cotton tipped swabs of the inferior fornix were taken at baseline and at months 1, 2 and 3 prior to each injection. Samples were cultured and antibiotic sensitivity was recorded by MIC50 levels. The data was analyzed for differences in antibiotic resistance.
Of 177 patients included in the study, 82 received antibiotics post injections and 93 did not. The mean age was 81 years. The culture positive rate at baseline was 28.0% in the antibiotic group and 14.5% in the no antibiotic group. In the antibiotic group, the culture positive rate increased monthly to 34.7% at month 1, 38.0% at month 2 and 41.8% at month 3. In the no antibiotic group, the culture positive rate was 22.2% at month 1, 8.8% at month 2 and 22.2% at month 3. The most common organism cultured was coagulase negative staphylococcus (75%) followed by diphtheroid (22.9%), staphylococcus aureus (6.3%) and streptococcus viridians (4.9%). In the antibiotic group, there was a significant change in MIC50 for moxifloxacin from 0.105 at baseline, to 0.549 at month 1, 0.184 at month 2 and 1.184 at month 3 (p = 0.0106). In the no antibiotic group, the MIC50 for moxifloxacin was 0.439 at baseline, 0.469 at month 1, 0.0052 at month 2 and 0.687 at month 3 (p = 0.102). There were no cases of endophthalmitis.
Patients treated with repeated use of topical moxifloxacin post intravitreal ranibizumab showed a significant increase in antibiotic resistance of the ocular surface flora at 3 months compared to those not given prophylactic topical antibiotics.
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