title: Conjunctival flora antibiotic resistance patterns after serial intravitreal injections without postinjection topical antibiotics.
abstract: OBJECTIVE
  To report conjunctival bacterial flora antibiotic resistance patterns after serial intravitreal injections performed using a povidone-iodine preparation without the use of preinjection or postinjection topical antibiotics.
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  
  
  
  METHODS
  Single-center clinical practice in Pennsylvania.
  
  
  METHODS
  Thirteen eyes of 13 treatment-naïve patients undergoing serial intravitreal anti-vascular endothelial growth factor (VEGF) injections for exudative age-related macular degeneration or macular edema attributable to retinal vein occlusion.
  
  
  METHODS
  Conjunctival cultures from the treatment eye were performed prior to each injection preparation. A minimum of 3 monthly conjunctival cultures were obtained per eye over the course of the study. Ocular surface preparation consisted of topical anesthetic and povidone-iodine 5% without the use of preinjection or postinjection topical antibiotics.
  
  
  METHODS
  Conjunctival flora growth patterns and antibiotic resistance patterns to several common antibiotics tested over the course of the study.
  
  
  RESULTS
  A total of 48 cultures were performed with a 77% culture positivity rate. Over the course of the serial conjunctival cultures in each patient, there was no evidence for emergence of resistant bacteria to any of the tested antibiotics (including fluoroquinolones and azithromycin) or significant alteration from baseline conjunctival flora. Of the 47 bacterial isolates, the most commonly isolated organism was coagulase-negative Staphylococcus both at baseline (73%) and following serial intravitreal injections (78%, P = .73).
  
  
  CONCLUSIONS
  Ocular surface preparation for intravitreal injection using povidone-iodine 5% alone in the absence of postinjection topical antibiotics does not appear to promote bacterial resistance or a discernible change in conjunctival flora.
authors: Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania. Electronic address: jhsu@midatlanticretina.com.
authors: Jason
authors: J
authors: Hsu
authors: Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
authors: Adam T
authors: AT
authors: Gerstenblith
authors: Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
authors: Sunir J
authors: SJ
authors: Garg
authors: Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania.
authors: James F
authors: JF
authors: Vander
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D003228:Conjunctiva / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D009877:Endophthalmitis / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D011206:Povidone-Iodine