Porównanie wrażliwości bakterii na lewofloksacynę i azytromycynę w profilaktyce pooperacyjnego zapalenia wnętrza gałki ocznej po iniekcjach doszklistkowych
The Comparison of Susceptibility of Conjunctival Bacterial Flora to Levofloxacin and Azithromycin (Used in the Prophylaxis of Postoperative Endophthalmitis) in Patients with Intravitreal Infections
Iwona Grabska-Liberek, Michał Kamiński, Aldona Krzyżewska, Urszula Łukasik, Katarzyna Skonieczna
Klinika Okulistyki Centrum Medycznego Kształcenia Podyplomowego w Warszawie
Kierownik: dr hab. n. med. Iwona Grabska-Liberek
Summary: Purpose: To evaluate the bacterial susceptibility to antibiotics – levofloxacin and azithromycin used in the prophylaxis of postoperative endophthalmitis in patients undergoing intravitreal Anti-Vascular Endothelial Growth Factor injections.
Methods: The study included 60 eyes of 60 patients who underwent intravitreal injection of anti-VEGF agent. Patients were divided into two groups of 30 people. First group of patients received topical levofloxacin four times daily for seven days, beginning two days before the surgery. Second group received topical azithromycin twice daily for three days, starting one day before the surgery. Conjunctival cultures in both groups were obtained on the day of surgery, before povidone-iodine application, and on the seventh day from the first dose of eye drops. Conjunctival swabs were inoculated on broth and solid culture media to determine bacterial growth and antibiotic susceptibility.
Results: On the day of intravitreal injection 9 eyes (30%) of 30 in levofloxacin group had positive culture results compared with 10 (33.33%) in azithromycin group. On the seventh day from the first dose of topical antibiotic 11 eyes (36.66%) of 30 in levofloxacin group had positive culture results compared with 8 (26.66%) in azithromycin group. The most frequently isolated bacterial strain was Coagulase-negative Staphylococcus (60% of all positive cultures). In the levofloxacin group 8.3% of isolated bacterial strains demonstrated in vitro resistance to levofloxacin. In the azithromycin group 78% of bacterial strains demonstrated resistance to used antibiotic.
Conclusions: Preoperative treatment with topical levofloxacin and azithromycin seem to reduce the frequency of conjunctival bacterial growth in similar extent. Ocular bacteria are more susceptible to levofloxacin than to azithromycin.
Słowa kluczowe: zapalenie wnętrza gałki ocznej, azytromycyna, lewofloksacyna, profilaktyka okołooperacyjna, iniekcje doszklistkowe.
Keywords: endophthalmitis, azithromycin, levofloxacin, topical antibiotic prophylaxis, intravitreal injection.