Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital
Purpose To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery. Design Retrospective, clinical registry. Participants All charity and private patients (116 714 eyes) wh...
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| Veröffentlicht in: | Ophthalmology (Rochester, Minn.) Minn.), 2016-02, Vol.123 (2), p.302-308 |
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| creator | Haripriya, Aravind, MD Chang, David F., MD Namburar, Sathvik Smita, Anand, MS Ravindran, Ravilla D., MD |
| description | Purpose To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery. Design Retrospective, clinical registry. Participants All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin. Methods The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated. Main Outcome Measures Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost. Results Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis ( P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate ( P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases. Conclusions Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification. |
| doi_str_mv | 10.1016/j.ophtha.2015.09.037 |
| format | Article |
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Design Retrospective, clinical registry. Participants All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin. Methods The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated. Main Outcome Measures Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost. Results Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis ( P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate ( P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases. Conclusions Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.</description><identifier>ISSN: 0161-6420</identifier><identifier>EISSN: 1549-4713</identifier><identifier>DOI: 10.1016/j.ophtha.2015.09.037</identifier><identifier>PMID: 26522705</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Anterior Chamber - drug effects ; Anti-Bacterial Agents - economics ; Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis ; Cataract Extraction ; Charities ; Drug Costs ; Electronic Health Records - statistics & numerical data ; Endophthalmitis - epidemiology ; Endophthalmitis - microbiology ; Endophthalmitis - prevention & control ; Eye Infections, Bacterial - epidemiology ; Eye Infections, Bacterial - microbiology ; Eye Infections, Bacterial - prevention & control ; Fluoroquinolones - economics ; Fluoroquinolones - therapeutic use ; Health Care Costs ; Hospitals, Private ; Hospitals, Public ; Hospitals, Special ; Humans ; India - epidemiology ; Male ; Middle Aged ; Moxifloxacin ; Ophthalmology ; Postoperative Complications ; Registries ; Retrospective Studies</subject><ispartof>Ophthalmology (Rochester, Minn.), 2016-02, Vol.123 (2), p.302-308</ispartof><rights>American Academy of Ophthalmology</rights><rights>2016 American Academy of Ophthalmology</rights><rights>Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-dc0041965ac15522c9d624d532940f9863dd02e418688774c2b6ebcf2aa840de3</citedby><cites>FETCH-LOGICAL-c417t-dc0041965ac15522c9d624d532940f9863dd02e418688774c2b6ebcf2aa840de3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S016164201501115X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26522705$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haripriya, Aravind, MD</creatorcontrib><creatorcontrib>Chang, David F., MD</creatorcontrib><creatorcontrib>Namburar, Sathvik</creatorcontrib><creatorcontrib>Smita, Anand, MS</creatorcontrib><creatorcontrib>Ravindran, Ravilla D., MD</creatorcontrib><title>Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital</title><title>Ophthalmology (Rochester, Minn.)</title><addtitle>Ophthalmology</addtitle><description>Purpose To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery. Design Retrospective, clinical registry. Participants All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin. Methods The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated. Main Outcome Measures Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost. Results Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis ( P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate ( P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases. Conclusions Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.</description><subject>Aged</subject><subject>Anterior Chamber - drug effects</subject><subject>Anti-Bacterial Agents - economics</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic Prophylaxis</subject><subject>Cataract Extraction</subject><subject>Charities</subject><subject>Drug Costs</subject><subject>Electronic Health Records - statistics & numerical data</subject><subject>Endophthalmitis - epidemiology</subject><subject>Endophthalmitis - microbiology</subject><subject>Endophthalmitis - prevention & control</subject><subject>Eye Infections, Bacterial - epidemiology</subject><subject>Eye Infections, Bacterial - microbiology</subject><subject>Eye Infections, Bacterial - prevention & control</subject><subject>Fluoroquinolones - economics</subject><subject>Fluoroquinolones - therapeutic use</subject><subject>Health Care Costs</subject><subject>Hospitals, Private</subject><subject>Hospitals, Public</subject><subject>Hospitals, Special</subject><subject>Humans</subject><subject>India - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Moxifloxacin</subject><subject>Ophthalmology</subject><subject>Postoperative Complications</subject><subject>Registries</subject><subject>Retrospective Studies</subject><issn>0161-6420</issn><issn>1549-4713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9u1DAQxi0EokvhDRDKkUvC-E-c5IJUVQutVFQkQEJcLK89Ub048WJnq83b9Fn6ZHhJ6YELp_FIv5nP832EvKZQUaDy3bYKu5vpRlcMaF1BVwFvnpAVrUVXiobyp2SVMVpKweCEvEhpCwBScvGcnDBZM9ZAvSI_1n3vjDZzEfricpyiNnrAqH3xKRxc78NBGzcW69Euan5wk0vF55jb2etDfuupOIv61o22WM94f3cR0s5N2r8kz3rtE756qKfk24f11_OL8ur64-X52VVpBG2m0hoAQTtZa0Pr_C3TWcmErTnrBPRdK7m1wFDQVrZt0wjDNhI3pmdatwIs8lPydtm7i-HXHtOkBpcMeq9HDPukaCOhbTvOm4yKBTUxpBSxV7voBh1nRUEdXVVbtdypjq4q6BT8GXvzoLDfDGgfh_7amIH3C4D5zluHUSXjcDRoXUQzKRvc_xT-XWC8G3Mw_ifOmLZhH8fsoaIqMQXqyzHZY7C0Bkpp_Z3_BsPIoHI</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Haripriya, Aravind, MD</creator><creator>Chang, David F., MD</creator><creator>Namburar, Sathvik</creator><creator>Smita, Anand, MS</creator><creator>Ravindran, Ravilla D., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160201</creationdate><title>Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital</title><author>Haripriya, Aravind, MD ; Chang, David F., MD ; Namburar, Sathvik ; Smita, Anand, MS ; Ravindran, Ravilla D., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-dc0041965ac15522c9d624d532940f9863dd02e418688774c2b6ebcf2aa840de3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Anterior Chamber - drug effects</topic><topic>Anti-Bacterial Agents - economics</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic Prophylaxis</topic><topic>Cataract Extraction</topic><topic>Charities</topic><topic>Drug Costs</topic><topic>Electronic Health Records - statistics & numerical data</topic><topic>Endophthalmitis - epidemiology</topic><topic>Endophthalmitis - microbiology</topic><topic>Endophthalmitis - prevention & control</topic><topic>Eye Infections, Bacterial - epidemiology</topic><topic>Eye Infections, Bacterial - microbiology</topic><topic>Eye Infections, Bacterial - prevention & control</topic><topic>Fluoroquinolones - economics</topic><topic>Fluoroquinolones - therapeutic use</topic><topic>Health Care Costs</topic><topic>Hospitals, Private</topic><topic>Hospitals, Public</topic><topic>Hospitals, Special</topic><topic>Humans</topic><topic>India - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Moxifloxacin</topic><topic>Ophthalmology</topic><topic>Postoperative Complications</topic><topic>Registries</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haripriya, Aravind, MD</creatorcontrib><creatorcontrib>Chang, David F., MD</creatorcontrib><creatorcontrib>Namburar, Sathvik</creatorcontrib><creatorcontrib>Smita, Anand, MS</creatorcontrib><creatorcontrib>Ravindran, Ravilla D., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Ophthalmology (Rochester, Minn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haripriya, Aravind, MD</au><au>Chang, David F., MD</au><au>Namburar, Sathvik</au><au>Smita, Anand, MS</au><au>Ravindran, Ravilla D., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital</atitle><jtitle>Ophthalmology (Rochester, Minn.)</jtitle><addtitle>Ophthalmology</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>123</volume><issue>2</issue><spage>302</spage><epage>308</epage><pages>302-308</pages><issn>0161-6420</issn><eissn>1549-4713</eissn><abstract>Purpose To compare the rate of postoperative endophthalmitis before and after initiation of intracameral (IC) moxifloxacin for endophthalmitis prophylaxis in patients undergoing cataract surgery. Design Retrospective, clinical registry. Participants All charity and private patients (116 714 eyes) who underwent cataract surgery between February 15, 2014, and April 15, 2015, at the Madurai Aravind Eye Hospital were included. Group 1 consisted of 37 777 eyes of charity patients who did not receive IC moxifloxacin, group 2 consisted of 38 160 eyes of charity patients who received IC moxifloxacin prophylaxis, and group 3 consisted of 40 777 eyes of private patients who did not receive IC moxifloxacin. Methods The electronic health record data for each of the 3 groups were analyzed, and the postoperative endophthalmitis rates were statistically compared. The cost of endophthalmitis treatment (groups 1 and 2) and the cost of IC moxifloxacin prophylaxis (group 2) were calculated. Main Outcome Measures Postoperative endophthalmitis rate before and after initiation of IC moxifloxacin endophthalmitis treatment cost. Results Manual, sutureless, small incision cataract surgery (M-SICS) accounted for approximately all of the 75 937 cataract surgeries in the charity population (97%), but only a minority of the 40 777 private surgeries (21% M-SICS; 79% phacoemulsification). Thirty eyes in group 1 (0.08%) and 6 eyes in group 2 (0.02%) were diagnosed with postoperative endophthalmitis ( P < 0.0001). The group 3 endophthalmitis rate was 0.07% (29 eyes), which was also higher than the second group's rate ( P < 0.0001). There were no adverse events attributed to IC moxifloxacin in group 2. The total cost of treating the 30 patients with endophthalmitis in group 1 was virtually identical to the total combined cost in group 2 of routine IC moxifloxacin prophylaxis and treatment of the 6 endophthalmitis cases. Conclusions Routine IC moxifloxacin prophylaxis achieved a highly significant, 4-fold reduction in postoperative endophthalmitis in patients undergoing M-SICS. Compared with previous studies, having such a high volume of patients undergoing surgery during a relatively short 14-month time period strengthens the conclusion. This study provides further evidence that moxifloxacin is an effective IC prophylactic antibiotic and suggests that IC antibiotics should be considered for M-SICS and phacoemulsification.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26522705</pmid><doi>10.1016/j.ophtha.2015.09.037</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Anterior Chamber - drug effects Anti-Bacterial Agents - economics Anti-Bacterial Agents - therapeutic use Antibiotic Prophylaxis Cataract Extraction Charities Drug Costs Electronic Health Records - statistics & numerical data Endophthalmitis - epidemiology Endophthalmitis - microbiology Endophthalmitis - prevention & control Eye Infections, Bacterial - epidemiology Eye Infections, Bacterial - microbiology Eye Infections, Bacterial - prevention & control Fluoroquinolones - economics Fluoroquinolones - therapeutic use Health Care Costs Hospitals, Private Hospitals, Public Hospitals, Special Humans India - epidemiology Male Middle Aged Moxifloxacin Ophthalmology Postoperative Complications Registries Retrospective Studies |
| title | Efficacy of Intracameral Moxifloxacin Endophthalmitis Prophylaxis at Aravind Eye Hospital |
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