Antibiotic prophylaxis and intravitreal injections: impact on the incidence of acute endophthalmitis

Abstract

Purpose : To study the role of antibiotic prophylaxis in reducing the risk of acute endophthalmitis after intravitreal injections, in France, between 1 January 2012 and 31 December 2015.

Methods : The French national inter-scheme health insurance information system was used to estimate the incidence rate of acute endophthalmitis after intravitreal injection (IVT) at a national scale and its risk factors. The occurrence of acute endophthalmitis was sought within 42 days after the IVT. Its association with age, sex, diabetes, injected product, and topical antibiotic prophylaxis was analyzed by multivariate Poisson regression.

Results : A total of 1,811,977 intravitreal injections were performed on 254,927 patients. The proportion of IVT with antibiotic prophylaxis for anti-VEGF and corticosteroids from 2013 to 2015, dropped from 82.7% to 59.1% and 84.8% to 64.2%, respectively. Acute endophthalmitis occurred in 444 cases (incidence rate = 0.0245%). The number of endophthalmitis in the absence of antibiotic prophylaxis was 114 for anti-VEGF and 14 for corticosteroids IVTs. The time to onset of endophthalmitis did not differ according to the status of antibiotic prophylaxis. Univariate analysis on repeated data did not find any difference in risk depending on the status of antibiotic prophylaxis or therapeutic classes but showed an increased risk of endophthalmitis for antibiotics associated with corticosteroids compared to antibiotics alone (IRR 1.67; 95% CI 1.08-2.57; P= .02). This finding did not remain significant in multivariate analyses.

Conclusions : These results are consistent with the literature. Endophthalmitis rates with or without antibiotic prophylaxis are similar. Avoiding antibiotic prophylaxis would reduce the costs as well as the risks of antibiotic resistance.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.