Endophthalmitis after cataract surgery and effect of different intracameral antibiotic regimes in Sweden 2011-2017: National registry study

Purpose:To study the incidence, predictive factors, etiology, and visual consequences of postoperative endophthalmitis (PE) in relation to 3 intracameral (IC) antibiotic regimes.Setting:Swedish National Cataract Register entries from 2011 through 2017.Design:Observational retrospective study.Methods:PE incidence, influencing factors, bacteriology, and visual outcome were analyzed regarding the 3 major prophylactic IC protocols.Results:The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per IC regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin, and 0.017% (20 cases in 121 045 surgeries) for combined cefuroxime-Ampicillin. Incidences were not statistically significantly different from one another. Gram-positive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with IC cefuroxime than with moxifloxacin, P =.006, or cefuroxime-Ampicillin, P <.001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, P <.001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-Ampicillin, 60.0%, P =.015, or with moxifloxacin, 88.2%, P <.001. Visual outcome worse than 20/200 was similar in the groups ranging from 42.0% to 53.7%.Conclusions:No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in etiology and bacterial sensitivity were found between the prophylactic IC treatments.