An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab

Roger A. Goldberg, Harry W Flynn, Ryan F. Isom, Darlene Miller, Serafin Gonzalez

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalAmerican Journal of Ophthalmology
Volume153
Issue number2
DOIs
StatePublished - Feb 1 2012

Fingerprint

Intravitreal Injections
Endophthalmitis
Streptococcus
Disease Outbreaks
Streptococcus oralis
Streptococcus mitis
Syringes
Microbiology
Bevacizumab
Injections
Emergency Treatment
Vitrectomy
Tertiary Healthcare
Fingers
Visual Acuity
Medical Records
Hospital Emergency Service
Referral and Consultation

ASJC Scopus subject areas

  • Ophthalmology

Cite this

An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab. / Goldberg, Roger A.; Flynn, Harry W; Isom, Ryan F.; Miller, Darlene; Gonzalez, Serafin.

In: American Journal of Ophthalmology, Vol. 153, No. 2, 01.02.2012.

Research output: Contribution to journalArticle

@article{286ea1471b5b454ba975222922720585,
title = "An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab",
abstract = "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.",
author = "Goldberg, {Roger A.} and Flynn, {Harry W} and Isom, {Ryan F.} and Darlene Miller and Serafin Gonzalez",
year = "2012",
month = "2",
day = "1",
doi = "10.1016/j.ajo.2011.11.035",
language = "English",
volume = "153",
journal = "American Journal of Ophthalmology",
issn = "0002-9394",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - An outbreak of streptococcus endophthalmitis after intravitreal injection of bevacizumab

AU - Goldberg, Roger A.

AU - Flynn, Harry W

AU - Isom, Ryan F.

AU - Miller, Darlene

AU - Gonzalez, Serafin

PY - 2012/2/1

Y1 - 2012/2/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84862907626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862907626&partnerID=8YFLogxK

U2 - 10.1016/j.ajo.2011.11.035

DO - 10.1016/j.ajo.2011.11.035

M3 - Article

C2 - 22264943

AN - SCOPUS:84862907626

VL - 153

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

SN - 0002-9394

IS - 2

ER -