From Harkness Eye Institute (Libre), Columbia University Medical Center, New York, New York, and Norwalk Hospital (Libre), Norwalk, and the University of Connecticut (Mathews), Storrs, Connecticut, USA.
From Harkness Eye Institute (Libre), Columbia University Medical Center, New York, New York, and Norwalk Hospital (Libre), Norwalk, and the University of Connecticut (Mathews), Storrs, Connecticut, USA.
J Cataract Refract Surg. 2017 Jun;43(6):833-838. doi: 10.1016/j.jcrs.2017.04.028.
To compare the efficacy of intracameral vancomycin, cefuroxime, and moxifloxacin on postoperative bacterial endophthalmitis rates.
Norwalk Hospital, Norwalk, Connecticut, USA.
Experimental study.
Bacteria and intraocular lenses (IOLs) were incubated with vancomycin, cefuroxime, moxifloxacin, or combinations. Antibiotic concentrations were high, corresponding to clinical maximum intracameral doses (1.0 mg vancomycin or cefuroxime, 0.5 mg moxifloxacin), or low (one third of clinical maximum dose). The following bacteria were isolated from patients with endophthalmitis: 18 strains including 6 staphylococci, 6 streptococci, 3 pseudomonad, and 3 propionibacteria. Samples were diluted by half every 2 hours to model the half-life of intracameral antibiotics. At 24 hours, samples were vortexed to shake bacterial biofilms loose from the IOLs. The bacterial broth was plated and colonies were counted 24 hours later.
Efficacy against staphylococci was concentration dependent; all antibiotics were effective at high concentrations, while low concentrations were in general ineffective. Streptococci and propionibacteria were nearly eliminated by all antibiotics at low concentrations. Pseudomonads were most effectively treated by high-dose moxifloxacin and its combinations.
Broadest coverage against common pathogens should be obtained by high-dose moxifloxacin (0.5 mg intracameral). Submaximum dosing, which could occur if aqueous is released to lower intraocular pressure after injection, compromises the efficacy against staphylococci and pseudomonads. All antibiotics, even at low doses, were effective against streptococci and propionibacteria, suggesting that many of the worst endophthalmitis outcomes could be prevented by intracameral use of any of the 3 antibiotics used in this study.
比较玻璃体内万古霉素、头孢呋辛和莫西沙星对术后细菌性眼内炎发生率的疗效。
美国康涅狄格州诺沃克市诺沃克医院。
实验研究。
将细菌和人工晶状体（IOL）与万古霉素、头孢呋辛、莫西沙星或其组合孵育。抗生素浓度较高，相当于临床最大玻璃体内剂量（1.0mg 万古霉素或头孢呋辛，0.5mg 莫西沙星），或较低（临床最大剂量的三分之一）。从患有眼内炎的患者中分离出以下细菌：18 株，包括 6 株葡萄球菌、6 株链球菌、3 株假单胞菌和 3 株丙酸杆菌。样品每 2 小时稀释一半，以模拟玻璃体内抗生素的半衰期。24 小时后，将样品涡旋以将细菌生物膜从 IOL 上摇松。将细菌肉汤平板稀释并在 24 小时后计算菌落数。
对葡萄球菌的疗效与浓度有关；所有抗生素在高浓度时均有效，而低浓度时通常无效。链球菌和丙酸杆菌在低浓度时几乎被所有抗生素消除。高剂量莫西沙星及其组合对假单胞菌最有效。
通过高剂量莫西沙星（0.5mg 玻璃体内）获得最广泛的覆盖常见病原体。如果注射后房水释放以降低眼内压，则会出现亚最大剂量，从而影响葡萄球菌和假单胞菌的疗效。所有抗生素，即使在低剂量时，对链球菌和丙酸杆菌也有效，这表明本研究中使用的 3 种抗生素中的任何一种都可以通过玻璃体内使用来预防许多最坏的眼内炎结局。
