Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis—A Nationwide Study in France from 2009 to 2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Data Extraction
2.3. Statistical Analysis
3. Results
4. Discussion
4.1. Limitations
- First, concerning the event under study, acute post-IVT endophthalmitis was defined by the record of a hospital stay for endophthalmitis. In France, the practice is to admit patients with endophthalmitis to hospital. In addition, the consumption of care (i.e., procedures, hospitalizations, and medication) was verified in those cases. Finally, although we could not obtain laboratory confirmation of the diagnosis, it is well documented that this piece of information is missing in a substantial number of cases [36]. Moreover, the incidence found in our national cohort was very close to that found in the literature [20,37,38].
- Third, the potential role of patient adherence to their drops once prescriptions were delivered may have to be taken into consideration.
- Fifth, we could not adjust our data to systemic or local infectious risk factors such as immunosuppression, except for diabetic status or conjunctiva at risk.
- Sixth, we limited our main outcome measures to infectious events occurring in the 42 days following the procedure, as defined by the Endophthalmitis Vitrectomy Study Group (EVS) [13]. However, our results were consistent with previous findings that 90% of endophthalmitis cases occurred within the first 2 weeks.
- Seventh, our findings cannot be fully extended to other countries; French guidelines for IVTs are somewhat different from American guidelines [40,41]. In France, performing IVTs in a dedicated room wearing sterile gloves is recommended. There does not appear to be any difference in the risk of endophthalmitis depending on the setting of the injection [42] and the use of sterile gloves or not [43,44]. In contrast, similar recommendations in these two countries include topical povidone-iodine use, surgical mask wear, and the absence of topical antibiotics [30,40,44]. Povidone-iodine is the only antiseptic technique that has been proven to decrease the risk of endophthalmitis after IVTs [45]. In France, the standard practice is to use povidone-iodine for all patients. Finally, the conclusions drawn from big data must be interpreted cautiously due to their limitations, as has already been pointed out in the ophthalmic literature [46]. While numerous potential confounders were adjusted in the analyses, other confounders not included or studied could be associated with the risk of endophthalmitis.
4.2. Strengths
- The subgroup size was large enough to detect a statistically significant difference between exposure groups;
- In a quasi-exhaustive population;
- Without exclusion criteria as found in RCTs or selected population studies (e.g., Medicare studies).
4.3. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Patient Data (n = 605,434) |
---|---|
Age, years | 79 (69–85) |
Sex, female | 356,196 (58.8%) |
Number of injections | 5 (3–11) |
Follow-up, days | 304 (61–1035) |
Patients with diabetes, n (%) | 187,918 (31.0%) |
Insulin-dependent patients with diabetes, n (%) | 93,556 (49.8%) |
Therapeutic Class | Agent | Frequency | Overall Proportion |
---|---|---|---|
Anti-VEGF | Bevacizumab | 13,567 | 0.26% |
Aflibercept | 1,455,218 | 27.50% | |
Ranibizumab | 3,337,135 | 63.07% | |
Pegaptanib | 9435 | 0.18% | |
Corticosteroid | Triamcinolone | 16,365 | 0.31% |
Dexamethasone | 199,751 | 3.77% | |
Unknown | 259,949 | 4.91% | |
TOTAL | 5,291,420 |
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Baudin, F.; Benzenine, E.; Mariet, A.-S.; Ghezala, I.B.; Bron, A.M.; Daien, V.; Gabrielle, P.-H.; Quantin, C.; Creuzot-Garcher, C. Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis—A Nationwide Study in France from 2009 to 2018. Pharmaceutics 2022, 14, 2133. https://doi.org/10.3390/pharmaceutics14102133
Baudin F, Benzenine E, Mariet A-S, Ghezala IB, Bron AM, Daien V, Gabrielle P-H, Quantin C, Creuzot-Garcher C. Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis—A Nationwide Study in France from 2009 to 2018. Pharmaceutics. 2022; 14(10):2133. https://doi.org/10.3390/pharmaceutics14102133
Chicago/Turabian StyleBaudin, Florian, Eric Benzenine, Anne-Sophie Mariet, Inès Ben Ghezala, Alain M. Bron, Vincent Daien, Pierre-Henry Gabrielle, Catherine Quantin, and Catherine Creuzot-Garcher. 2022. "Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis—A Nationwide Study in France from 2009 to 2018" Pharmaceutics 14, no. 10: 2133. https://doi.org/10.3390/pharmaceutics14102133
APA StyleBaudin, F., Benzenine, E., Mariet, A.-S., Ghezala, I. B., Bron, A. M., Daien, V., Gabrielle, P.-H., Quantin, C., & Creuzot-Garcher, C. (2022). Topical Antibiotic Prophylaxis and Intravitreal Injections: Impact on the Incidence of Acute Endophthalmitis—A Nationwide Study in France from 2009 to 2018. Pharmaceutics, 14(10), 2133. https://doi.org/10.3390/pharmaceutics14102133