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Matthew P Simunovic, Aaron Pin Chien Ong, Nikki Angbue Te, William Yates, Richard Symes, Sophia Zagora, Peter J McCluskey, Andrew Chang; Post-surgical versus post-intravitreal injection endophthalmitis: changing patterns in causative flora. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6173.
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We aimed to determine outcomes and the spectrum of causative organisms in acute (≤ 6 weeks post-procedure) post-surgical to acute post-intravitreal injection (IVI) endophthalmitis presenting to Sydney Eye Hospital during the period 1st July, 2012 to 31st July, 2017. We also aimed to compare these data to a previous analysis undertaken during the period 1st January, 2007 to 31st December, 2010 (Simunovic MP, et al.. Br J Ophthalmol 2012;96:862-866.).
Cases of acute post-cataract surgery and post-IVI endophthalmitis presenting to Sydney Eye Hospital - a tertiary referral hospital serving the state of New South Wales, Australia (population > 7.5 million) - were identified via electronic records. Cases were then scrutinized for patient demographics, medical and procedural history, culture results and outcomes following treatment.
During 2012-7, 190 cases were identified, of which 141 were post-IVI and 49 were post-cataract surgery: this represents a significant increase in the proportion of post-IVI cases over the 2007-10 time period (53 vs. 48 cases respectively, OR = 2.61; P = 0.0002). Causative organisms were identified in 54% of post-IVI and 45% of post-cataract surgery cases (OR =1.44; P = 0.32). Of the causative organisms, S. epidermidis remained the single most frequent causative organism, representing 58% of culture positive post-IVI cases and 41% of culture positive post-cataract cases (OR 1.44; P = 0.32). We found that Streptococcus species accounted for only 7% of culture positive post-IVI cases but 32% of post-surgical cases (OR = 0.15; P = 0.004). At 3 months, 84% of post-IVI and 81% of post-surgical cases had improved BCVA over presentation (OR 1.25; P = 0.65).
We found a significant increase in the proportion of endophthalmitis cases attributable to IVI when compared to cataract surgery in the period 2012-17 versus 2007-2010. Of culture positive cases, the single most common causative organism was S. epidermidis for both time periods. Interestingly, we observed a reversal in the increased burden of Strepococcus species endophthalmitis which had previously been found in association with IVI. We hypothesize that this reflects underlying changes in procedure, whereby practitioners are now aware of the risk of contamination with oral flora during IVI and have accordingly modified their practice.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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