The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center

Abstract

Our purpose was to compare postoperative infectious endophthalmitis rates before and after the introduction of antibiotic prophylaxis via intracameral with cefuroxime (ATB-P IC) in a high-volume cataract surgery service. Retrospective cohort study considering patients who underwent cataract surgery at Ophthal Hospital Especializado, São Paulo, Brazil, from January/2011 to December/2019. Patients operated from 2013 to 2019 comprised the ATB-P IC group while those operated from 2011 to 2013 formed the control group without the ATB-P IC protocol. A total of 23,184 cataract surgeries were included, with 6,207 in the Control Group and 16,977 in the ATB-P Group. A significantly higher rate of endophthalmitis was observed in the control group (0.0967%) when compared to the ATB-P group (0.0177%) (p = 0.014). Surgeries performed with ATB-P showed 80% less chance of reported endophthalmitis (OR = 0.20; 95% CI 0.05–0.72; p = 0.014) than those without ATB-P. Of the six cases confirmed by culture in the control group, all tested positive for Pseudomonas aeroginosa and the only case confirmed by culture in the ATB-P group was positive for Staphylococcus epidermidis. Our findings strongly support the use of intracameral antibiotic prophylaxis with cefuroxime to reduce postoperative infectious endophthalmitis rates, and we recommend its incorporation into cataract surgery protocols.

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis

“…Another RCT studied intracameral 0.5% moxifloxacin and reported that intracameral moxifloxacin was associated with a reduced rate of endophthalmitis [ 94 ]. In addition, many retrospective series and prospective studies have reported benefits with intracameral antibiotic prophylaxis in cataract surgery [ 88 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ]. Further, several meta-analyses have also supported the use of intracameral antibiotics, highlighting a greater effectiveness of this route as a prophylactic measure and a lack of additional benefits from topical antibiotic administration [ 100 , 105 , 106 ].…”