An Outbreak of Streptococcus Endophthalmitis After Intravitreal Injection of Bevacizumab
An Outbreak of Streptococcus Endophthalmitis After Intravitreal Injection of Bevacizumab
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DOI：
10.1016/j.ajo.2011.11.035
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发表时间：
2012-02-01
影响因子：
4.2
通讯作者：
Gonzalez, Serafin
中科院分区：
文献类型：
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作者：
Goldberg, Roger A.;Flynn, Harry W., Jr.;Gonzalez, Serafin
目的：报道一系列由同一复合药房制备的贝伐单抗玻璃体内注射后并发眼内链球菌炎的患者。设计：非比较的连续病例系列。方法：回顾2011年7月5日至7月8日期间玻璃体内注射贝伐单抗后出现眼内炎的患者的医疗记录和微生物学结果。结果：12例患者在接受贝伐单抗玻璃体内注射后1至6天出现眼内炎。注射发生在佛罗里达州南部的4个不同地点。所有患者均接受由同一复方药房制备的贝伐单抗。虽然有9名患者到佛罗里达州迈阿密的巴斯科姆帕尔默眼科研究所的三级眼科急诊室接受治疗，另有3名患者就诊，但没有一例感染来自该研究所。所有患者最初均接受玻璃体穿刺和注射治疗；8例患者随后接受玻璃体切除术。10例患者微生物培养阳性。同时配制的7支未使用的贝伐单抗注射器与患者配制的贝伐单抗注射器也呈S. mitis/oral阳性。随访4个月后，除1例患者外，其余患者均有数指或视力较差，3例患者需要摘除或去核。当地、州和联邦卫生部门的官员一直在调查污染源。结论：在这次玻璃体内注射贝伐单抗后的眼内炎暴发中，从大多数患者和所有未使用的注射器中培养出了mitis/oral链球菌。视力结果普遍较差。这次爆发最可能的原因是配药药房在注射器制备过程中受到污染。[J]中华眼科杂志，2012;33(3):391 - 391。(C) 2012年Elsevier Inc.版权所有。)
PURPOSE: To report a series of patients with Streptococcus endophthalmitis after injection with intravitreal bevacizumab prepared by the same compounding pharmacy.DESIGN: Noncomparative consecutive case series.METHODS: Medical records and microbiology results of patients who presented with endophthalmitis after injection with intravitreal bevacizumab between July 5 and July 8, 2011, were reviewed.RESULTS: Twelve patients were identified with endophthalmitis, presenting 1 to 6 days after receiving an intravitreal injection of bevacizumab. The injections occurred at 4 different locations in south Florida. All patients received bevacizumab prepared by the same compounding pharmacy. None of the infections originated at the Bascom Palmer Eye Institute, Miami, Florida, although 9 patients presented to its tertiary-care ophthalmic emergency room for treatment, and 3 additional patients were seen in consultation. All patients were treated initially with a vitreous tap and injection; 8 patients subsequently received a vitrectomy. Microbiology cultures for 10 patients were positive for Streptococcus mitis/oralis. Seven unused syringes of bevacizumab prepared by the compounding pharmacy at the same time as those prepared for the affected patients also were positive for S. mitis/oralis. After 4 months of follow-up, all but 1 patient had count fingers or worse visual acuity, and 3 required evisceration or enucleation. Local, state, and federal health department officials have been investigating the source of the contamination.CONCLUSIONS: In this outbreak of endophthalmitis after intravitreal bevacizumab injection, Streptococcus mitis/oralis was cultured from the majority of patients and from all unused syringes. Visual outcomes were generally poor. The most likely cause of this outbreak was contamination during syringe preparation by the compounding pharmacy. (Am J Ophthalmol 2012;153:204-208. (C) 2012 by Elsevier Inc. All rights reserved.)