Home

Clinical and economic analysis of antibiotic prophylaxis in the surgical treatment of cataracts

Written by Fedyashev G.A., Eliseeva E.V.

  UDK: 617.741-004.1-089:615.1:33 DOI: 10.17238/PmJ1609-1175.2016.3.62–64 | Pages: 62–64 | Full text PDF | Open PDF 

Annotation:

Objective. The purpose of the study is an assessment of the clinical and cost-effectiveness of perioperative antibiotic prophylaxis systemic fluoroquinolones cataract. Methods. It was conducted a retrospective randomized study of the incidence of postoperative infectious complications that developed after the 9314 cataract surgery carried out by ‹small sections’ technology from 2012 to 2014. Patients of the 1st group received 0.5 % levofloxacin instillation (4 times a day for three days before surgery), patients of the 2nd group received additional systemic levofloxacin (orally, 500 mg/day). We calculated relative risk (RR), relative risk reduction (RRR) and absolute risk reduction (ARR) of complications, and the number of patients needed to treat (NNT). Results. In the group of patients receiving antibiotic prophylaxis just as instillation fluoroquinolones , infection rates were 0.25 %, while in the group where the patients received additional systemic fluoroquinolone – 0.02 %. RR was 0.08, RRR – 0.92, ARR – 0.23 %, NNT was 422.8. Systemic antibiotic prophylaxis costs exceed the costs for local antibiotic prophylaxis 1.8 times. At the same time the costs of treatment which developed 12 endophthalmitis in the 1st group exceeded the cost of the system and antibiotic treatment of endophthalmitis after systemic use of levofloxacin. Conclusions. System use of fluoroquinolones in the perioperative period of cataract surgery is an effective method of preventing infectious postoperative complications, both in clinical and economic aspects.

Links to authors:

G.A. Fedyashev1, 2, E.V. Eliseeva1
1 Pacific State Medical university (2 Ostryakova Ave. Vladivostok 690950 Russian Federation),
2 Primorsky Center of Eye Microsurgery (100e Borisenko St. Vladivostok 690088 Russian Federation)


1. Vlasov V.V. Epidemiology: textbook. М.: GEOTAR-Media, 2004. 464 p.
2. Bandurova E.A., Shumatov V.B., Eliseeva E.V. Local microbiological monitoring and antibiotic resistance of the main pathogens in patients with surgical pathology in the intensive care unit // Pacific Medical Journal, 2012. No. 3. P. 25–29.
3. Barry P. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS endophthalmitis Study // J. Cataract. Refract. Surg. 2014. Vol. 40, No. 1. P. 138–142.
4. Braga-Mele R., Chang D.F., Henderson B.A. [et al.]. Intracameral antibiotics: safety, efficacy, and preparation // J. Cataract. Refract. Surg. 2014. Vol. 40, No. 12. P. 2134–2142.
5. ESCRS Guidelines for prevention and treatment of endophthalmitis following cataract surgery: data, dilemmas and conclusions 2013 / eds: Barry P., Cordovés L., Gardner S. ESCRS, 2013. 45 p.
6. George J.M., Fiscella R., Blair M. [et al.]. Aqueous and vitreous penetration of linezolid and levofloxacin after oral administration // J. Ocul. Pharmacol. Ther. 2010. Vol. 26, No. 6. P. 579–586.
7. Gower E.W., Keay L.J., Stare D.E. [et al.]. Characteristics of endophthalmitis after cataract surgery in the United States medicare population // Ophthalmology. 2015. Vol. 122, No. 8. P. 1625–1632.
8. Ishida M., Kataoka T., Niwa K. [et al.]. Efficient penetration into aqueous humor by administration of oral and topical levofloxacin // Ocul. Pharmacol. Ther. 2011. Vol. 27, No. 3. P. 247–250.
9. Kessel L., Flesner P., Andresen J. [et al.]. Antibiotic prevention of postcataract endophthalmitis: a systematic review and metaanalysis // Acta Ophthalmol. 2015. Vol. 93, No. 4. P. 303–317.
10. Matsuura K., Mori T., Miyamoto T., Suto C. [et al.]. Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery // Clin. Ophthalmol. 2014. Vol. 29, No. 8. P. 2013–2018.
11. Rudnisky C.J., Wan D., Weis E. Antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis // Ophthalmology. 2014. Vol. 121, No. 4. P. 835–841.
12. Sakamoto H., Sakamoto M., Hata Y. [et al.]. Aqueous and vitreous penetration of levofloxacin after topical and/or oral administration // Eur. J. Ophthalmol. 2007. Vol. 17, No. 3. P. 372–376.
13. Sharifi E., Porco T.C., Naseri A. Cost-effectiveness analysis of intracameral cefuroxime use for prophylaxis of endophthalmitis after cataract surgery // Ophthalmology. 2009. Vol. 116, No. 10. P. 1887–1896.
14. Vaziri K., Schwartz S.G., Kishor K., Flynn H.W. Endophthalmitis: state of the art // Clin. Ophthalmol. 2015. Vol. 9. P. 95–108.

PUBLISHER: "MEDITSYNA DV"

Founded in 1997  |  Editions in a year: 4, Articles in one issue: 30 |  ISSN of print version: 1609-1175  |  Ind.: 18410 (Agency "Rospechat’")  |  Edition: 1000 c.