Ocular Microbiology and Immunology Group
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2011 OMIG Abstract 10

An outbreak of Streptococcus endophthalmitis after intravitreal injection of bevacizumab
R.A. Goldberg, H.W. Flynn, Jr, D. Miller, R. Isom, S. Gonzalez
Department of Ophthalmology, Bascom Palmer Eye Institute, University  of Miami Miller School of Medicine, Miami, FL

Purpose: To report a series of patients with culture-positive endophthalmitis after injection with intravitreal bevacizumab prepared by the same compounding pharmacy.

Design/Methods: In a non-comparative consecutive case series, 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 1-6 days after intravitreal injection of bevacizumab. The injections occurred at four different locations in Miami-Dade and Broward Counties, and all patients received bevacizumab prepared by the same compounding pharmacy. None of the infections originated at the Bascom Palmer Eye Institute, although nine patients presented to its tertiary care ophthalmic emergency room for treatment, and two additional patients were seen in consultation. Of the ten patients for whom presenting signs and symptoms were available, seven (70%) presented with light-perception vision, while two presented with hand-motion vision (20%), and one (10%) had 20/200 vision. All patients were treated with initial diagnostic vitreous tap and injection of intravitreal antibiotics. Microbiology cultures for nine patients were positive for Streptococcus mitis/oralis, as were seven unused bevacizumab syringes prepared by the compounding pharmacy at the same time as those prepared for the affected patients. After one month of treatment, all patients showed signs of clinical improvement, although visual acuity remained poor: last recorded visual acuities were no light perception (2 patients), light perception (5 patients), hand motion (2 patients), 20/400 (1 patient), and 20/40 (1 patient). Local, state and federal health department officials were contacted, and have been investigating the source of the contamination.

Conclusions: Streptococcus mitis/oralis is a virulent microbe and has a poor visual prognosis in endophthalmitis. This is the largest reported outbreak of infectious endophthalmitis after intravitreal injection of bevacizumab prepared by a compounding pharmacy.

Disclosure: N

2011 Abstract List | < Previous | Next >