Evaluation of Microbial Risk Factors in Relation to Clinical Effectiveness of Off-Label Bevacizumab Use for Retinal Disease Treatment
Research Article
DOI:
https://doi.org/10.31580/pjmls.v9i1.3417Keywords:
Age-related macular degeneration, Bevacizumab, Endophthalmitis, Microbial risks, Off-label, Retinal disease, VEGFAbstract
The off-label application of Bevacizumab, which is a monoclonal antibody of vascular endothelial growth factor (VEGF), is extremely popular in the management of retinal diseases, such as diabetic retinopathy, age-related macular degeneration, and retinal vein occlusion. Even though there are clinical benefits of microbial contamination when using multi-dose vials, repackaging, and storing, the problem of contamination remains. The purpose of this study was to assess the microbiological safety of bevacizumab during repeated access of the vials, under the different storage conditions, and in the operating theatre (OT) setting.
The quota was the Helper Eye Hospital at Quetta, where an experimental/observational study was carried out. Twenty samples were sampled in five bevacizumab vials after multitasking at the various usage stages. Moreover, 20 repacked syringes were made with new and used vials and kept at room temperature and 4 °C during a maximum of 14 days. In the case of environmental surveillance, 120 swab samples of six OT sites were provided. All samples were grown in conventional microbiological media, and Kirby-Bauer disc diffusion test was applied to determine the antibiotic susceptibility test.
Bevacizumab samples showed no growth of microbes at any stage of vial use or storage condition, which proves the preserved sterility. Instead, there was evidence of contamination with Escherichia coli and Klebsiella pneumoniae, which are especially found on frequently touched OT surfaces in environmental samples. Isolates were resistant to a number of β-lactam antibiotics but sensitive to carbapenems, fluoroquinolones, and aminoglycosides.
These results indicate that bevacizumab is microbiologically stable under aseptic handling conditions, and the importance of taking stringent precautions to prevent infections in the OT setting to minimize the risk of post-injection infections.
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