The Use of Preoperative Prophylactic Systemic Antibiotics for the Prevention of Endopthalmitis in Open Globe Injuries: A Meta-Analysis

Tim J. Patterson, David McKinney, Jonathan Ritson, Chris McLean, Weidong Gu, Marcus Colyer, Scott F. McClellan, Sarah C. Miller, Grant A. Justin, Annette K. Hoskin, Kara Cavuoto, James Leong, Andrés Rousselot Ascarza, Fasika A. Woreta, Kyle E. Miller, Matthew C. Caldwell, William G. Gensheimer, Tom Williamson, Felipe Dhawahir-Scala, Peter ShahAndrew Coombes, Gangadhara Sundar, Robert A. Mazzoli, Malcolm Woodcock, Ferenc Kuhn, Stephanie L. Watson, Renata S.M. Gomes, Rupesh Agrawal, Richard J. Blanch*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
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Topic: This study reports the effect of systemic prophylactic antibiotics (and their route) on the risk of endophthalmitis after open globe injury (OGI). Clinical relevance: Endophthalmitis is a major complication of OGI; it can lead to rapid sight loss in the affected eye. The administration of systemic antibiotic prophylaxis is common practice in some health care systems, although there is no consensus on their use. Methods: PubMed, CENTRAL, Web of Science, CINAHL, and Embase were searched. This was completed July 6, 2021 and updated December 10, 2022. We included randomized and nonrandomized prospective studies which reported the rate of post-OGI endophthalmitis, when systemic preoperative antibiotic prophylaxis (via the oral or IV route) was given. The Cochrane Risk of Bias tool and ROBINS-I tool were used for assessing the risk of bias. Where meta-analysis was performed, results were reported as an odds ratio. PROSPERO registration: CRD42021271271. Results: Three studies were included. One prospective observational study compared outcomes of patients who had received systemic or no systemic preoperative antibiotics. The endophthalmitis rates reported were 3.75% and 4.91% in the systemic and no systemic preoperative antibiotics groups, a nonsignificant difference (P = 0.68). Two randomized controlled trials were included (1555 patients). The rates of endophthalmitis were 17 events in 751 patients (2.26%) and 17 events in 804 patients (2.11%) in the oral antibiotics and IV (± oral) antibiotics groups, respectively. Meta-analysis demonstrated no significant differences between groups (odds ratio, 1.07; 95% confidence interval, 0.54–2.12). Conclusions: The incidences of endophthalmitis after OGI were low with and without systemic antibiotic prophylaxis, although high-risk cases were excluded in the included studies. When antibiotic prophylaxis is considered, there is moderate evidence that oral antibiotic administration is noninferior to IV. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish
Pages (from-to)972-981
Number of pages10
JournalOphthalmology Retina
Issue number11
Early online date4 Jul 2023
Publication statusPublished - 1 Nov 2023
Externally publishedYes

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