Drug Dependency Increases Risk of Endogenous Endophthalmitis

Tahreem A. Mir, MD

There could be more complications caused by the opioid epidemic including an increase in hospital admissions for endogenous endophthalmitis.

A team, led by Tahreem A. Mir, MD, Department of Ophthalmology and Visual Science, Yale School of Medicine, reported on changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the US from 2003-2016.

In the nationwide, retrospective cross-sectional study, the investigators used National Inpatient Sample to identify 56,839 patients admitted with a diagnosis of endogenous endophthalmitis.

The investigators performed an analysis to identify national and regional trends in incidence and prevalence of associated infectious and noninfectious comorbidities in patients with or without a history of drug dependence or use. The team also calculated median and cumulative inflation-adjusted costs for admissions.

Of the 56,839 patients in the study, the investigators found 13.7% (n = 7783) had a history of drug dependence or use. This group was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P <0 .001) and skewed more male (61.8% [n = 35,127] vs 49.0% [n = 21,712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < 0.001).

Overall, the incidence of endogenous endophthalmitis linked to drug dependence or use rose from 0.08 per 100,000 individuals in 2003 to 0.32 per 100,000 people in 2016 across all 4 US geographic regions.

“A 4-fold increase in drug use–related endogenous endophthalmitis hospitalizations was observed in the United States from 2003 to 2016, resulting in substantial health care use burden,” the authors wrote. “These findings support the hypothesis that clinicians should maintain a high index of suspicion for endophthalmitis when evaluating patients with intraocular inflammation in the setting of drug dependence or use.”

The investigators also found the 4-fold increase in hospital admissions for endogenous endophthalmitis overall remained stable during the same time period, costing approximately $134 million.

Previously, researchers found prophylactic topical antibiotics did not decrease the rate of endophthalmitis following intravitreal injections.

In recent years, intravitreal injection has become a common medical procedure in the US typically used to treat diabetic macular edema and neovascular age-related macular degeneration.

While the invasive procedure is generally well tolerated, endophthalmitis is a rare complication with potentially devastating consequences.

In the past, many physicians prescribed topical ophthalmic antibiotics to prevent endophthalmitis after intravitreal injection. However, large clinical trials have not supported this practice, and guidelines have stated that insufficient evidence exists to endorse it, so it has fallen out of favor.

To determine the incidence of endophthalmitis after intravitreal injection and to compare the rate of endophthalmitis when prophylactic topical antibiotics were routinely used with that after their use was discontinued, records of all patients seen by Retina Consultants of Houston from 2011 through 2014 were retrospectively reviewed.

During the study period, 90,339 intravitreal injections were given, and 30 cases of endophthalmitis were identified, which resulted in an endophthalmitis rate of 0.033%, or approximately 1 case in 3011 intravitreal injections.

The study, “Incidence of Drug Use–Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016,” was published online in JAMA Ophthalmology.