title: Comparative Effectiveness of Antibiotic Prophylaxis in Cataract Surgery.
abstract: OBJECTIVE
  Intracameral injection is an effective method for preventing infection, but no controlled study has been published in the United States.
  
  
  METHODS
  We conducted an observational, longitudinal cohort study to examine the effect of topical and injected antibiotics on risk of endophthalmitis.
  
  
  METHODS
  We identified 315 246 eligible cataract procedures in 204 515 members of Kaiser Permanente, California, 2005-2012.
  
  
  METHODS
  The study used information from the membership, medical, pharmacy, and surgical records from the electronic health record.
  
  
  METHODS
  The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of antibiotic prophylaxis (route and agent) with risk of endophthalmitis was estimated using logistic regression analysis.
  
  
  RESULTS
  We confirmed 215 cases of endophthalmitis (0.07% or 0.7/1000). Posterior capsular rupture was associated with a 3.68-fold increased risk of endophthalmitis (CI, 1.89-7.20). Intracameral antibiotic was more effective than topical agent alone (OR, 0.58; CI, 0.38-0.91). Combining topical gatifloxacin or ofloxacin with intracameral agent was not more effective than using an intracameral agent alone (compared with intracameral only: intracameral plus topical, OR, 1.63; CI, 0.48-5.47). Compared with topical gatifloxacin, prophylaxis using topical aminoglycoside was ineffective (OR, 1.97; CI, 1.17-3.31).
  
  
  CONCLUSIONS
  Surgical complication remains a key risk factor for endophthalmitis. Intracameral antibiotic was more effective for preventing post-cataract extraction endophthalmitis than topical antibiotic alone. Topical antibiotic was not shown to add to the effectiveness of an intracameral regimen.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California. Electronic address: lisa.herrinton@kp.org.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.affiliation: Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California.
authors.forename: Neal H
authors.initials: NH
authors.lastname: Shorstein
authors.affiliation: Department of Ophthalmology, Kaiser Permanente, Pasadena, California.
authors.forename: John F
authors.initials: JF
authors.lastname: Paschal
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente, Pasadena, California.
authors.forename: Richard
authors.initials: R
authors.lastname: Contreras
authors.affiliation: Division of Infectious Diseases, Department of Ophthalmology, Oregon Health and Sciences University, Portland, Oregon.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
authors.affiliation: Department of Ophthalmology, Kaiser Permanente, Redwood City, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Chang
authors.affiliation: Department of Ophthalmology, Kaiser Permanente, Redwood City, California.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Melles
authors.affiliation: Department of Ophthalmology, Kaiser Permanente, Pasadena, California.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Fong
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D016208:Databases, Factual; D009877:Endophthalmitis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D056965:Injections, Intraocular; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018918:Phacoemulsification; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones