REPORTING INFECTIONS

An online registry sponsored by ESCRS is now available for reporting endophthalmitis cases throughout Europe, Peter Barry FRCS, FRCOphth, FRCSI told EuroTimes. The registry can be found at www.endophthalmitisregistry.com.

Intended to help identify and track patterns of infectious organisms and antimicrobial resistance, the registry is available free of charge for reporting suspected infections after cataract surgery or intravitreal injections, said Dr Barry, principal investigator in the landmark ESCRS Endophthalmitis Study that established the efficacy of prophylactic intracameral antibiotics.

“In Europe, with the widespread adoption of intracameral antibiotic prophylaxis in cataract surgery, the number of endophthalmitis cases everywhere is going dramatically down, but it is still there. To get some meaningful information on it we decided we would open up an ESCRS endophthalmitis registry, and cover endophthalmitis in association with intraocular injections as well,” Dr Barry said.

Indeed, injections may present the greater risk for patients. While the incidence of endophthalmitis per procedure is similar between cataract surgery and intraocular injections, the incidence per patient is much higher with injections at about 1:500 because they receive multiple injections, Dr Barry noted.

To report a suspected case, log on, select cataract surgery or injection, and enter information on the patient. The registry then assigns a unique identifying number to the case to maintain patient and surgeon confidentiality.

After 90 days, the registry automatically queries the reporting surgeon in confidence about the case, asking if it was confirmed as endophthalmitis. If the answer is yes, a series of further questions are asked, including:

• What was the infectious organism?

• How was the agent identified: Gram stain, culture, PCR or some combination?

• For cataract cases, were intracameral antibiotics used? If so, which one?

• Were topical antibiotics used? If so, which one?

• For intravitreal injections, how many injections had the patient had previously?

• Were topical antibiotics used before or after the injection? If so, which ones, and for how long?

• Which antiseptic was applied before injection, povidone iodine or chlorhexidine, and how long was the exposure time: less than one minute, one to three minutes, more than three minutes?

This data may be useful not only for tracking infectious organisms, but also for developing protocols for intravitreal injections that reduce the risk of infection and development of resistant organisms, Dr Barry said.

The proper use of topical antibiotics in patients receiving frequent injections is uncertain, Dr Barry said. Antiseptic practice is also uncertain, he added. Evidence-based cataract surgery protocols call for povidone iodine solution to be left in place for at least three minutes before commencing incisions. Registry data may help guide development of standard intraocular injection protocols, he said.

Peter Barry: peterbarryfrcs@theeyeclinic.ie