[Injection of cefuroxime into the vitreous cavity leading to toxic retinal damage: a case report].

A 36-year-old male patient presented with a decrease in vision after undergoing scleral suturing for a left eye injury caused by an iron hook, combined with intravitreal injection of cefuroxime. Ocular examination revealed extensive gray-white edematous areas in the macular region, along with focal serous shallow retinal detachment in the posterior pole. Following admission, comprehensive ophthalmic examinations were conducted, leading to the diagnosis of toxic retinal damage in the left eye. Treatment with oral corticosteroids and interventions to improve microcirculation were initiated, resulting in improved visual acuity. At the six-month follow-up, the patient's visual acuity had recovered to 0.5.

[Retrospective analysis of perioperative anaphylactic shock induced by cefuroxime].

This study investigated the characteristics and frequency of perioperative anaphylactic shock induced by cefuroxime, so as to provide a reference for the safe and rational use of cefuroxime in the perioperative period. Cases of perioperative anaphylactic shock caused by cefuroxime in our hospital from 2011 to 2021 were extracted from the Adverse Drug Reaction Monitoring System. Literature reporting adverse drug reactions (ADR) including cefuroxime-induced anaphylactic shock in perioperative settings was collected from the CNKI, VIP, Wanfang, PubMed, and Web of Science databases from their respective inception to May 2022. Statistical analysis was performed for all cases of cefuroxime-induced perioperative anaphylactic shock. A total of 31 patients were included [13 men (48.1%) and 14 women (51.9%)], most of whom were over 60 years old (n=16, 59.3%); 9 (29.0%) patients had a history of drug allergy; 5 (16.1%) patients had received skin tests, but with negative results; 28 (90.3%) patients received treatment intravenously; 22 (71.0%) patients were treated after anesthesia. For 20 (64.5%) patients the ADR occurred within 10 minutes after anesthesia. The main manifestations were hypotension, dyspnea, rash, and tachycardia. For all patients, symptoms resolved after withdrawal of the drug and active rescue, and there were no deaths. A history of allergy and skin test findings may have limitations in predicting perioperative anaphylactic shock caused by cefuroxime; greater vigilance should be exercised when using cefuroxime in the perioperative period. Close monitoring is recommended for patients undergoing treatment with cefuroxime. Rescue therapy should be administered for allergic shock, and suitable response measures must be taken in a timely manner to ensure the safety of patients.

Dietary nobiletin regulated cefuroxime- and levofloxacin-associated "gut microbiota-metabolism" imbalance and intestinal barrier dysfunction in mice.

Nobiletin (NOB) exhibits significant biological activities and may be a potential dietary treatment for antibiotic-associated gut dysbiosis. In this study, mice were gavaged with 0.2 mL day-1 of 12.5 g L-1 cefuroxime (LFX) and 10 g L-1 levofloxacin (LVX) for a duration of 10 days, accompanied by 0.05% NOB to investigate the regulatory effect and potential mechanisms of NOB on antibiotic-induced intestinal microbiota disorder and intestinal barrier dysfunction. Our results indicated that dietary NOB improved the pathology of intestinal epithelial cells and the intestinal permeability by upregulating the expression of intestinal tight junction proteins (TJs) and the number of goblet cells. Furthermore, dietary NOB reduced the levels of serum lipopolysaccharide (LPS) and pro-inflammatory factors (TNF-α and IL-1ß), thereby facilitating the restoration of the intestinal mucosal barrier. Additionally, dietary NOB increased the abundance of beneficial bacteria f_Lachnospiraceae and regulated the metabolic disorders of short-chain fatty acids (SCFAs) and bile acids (BAs). Notably, NOB supplementation resulted in elevated levels of butyric acid and lithocholic acid (LCA), which contributed to the repair of the intestinal mucosal barrier function and the maintenance of intestinal homeostasis. Collectively, our results propose a healthy dietary strategy for the prevention or mitigation of antibiotic-associated gut dysbiosis by dietary NOB.

Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery.

PURPOSE: To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. METHODS: Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5 mg/0.1 ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. RESULTS: All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P = .038), being <1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. CONCLUSIONS: Although 1 mg/0.1 ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Macular Edema and Serous Macular Detachment after a Standard Dose of Intracameral Cefuroxime.

Intracameral cefuroxime has been associated with postoperative macular edema and sub-retinal fluid. To date, nearly all published cases are attributed to errors in antibiotic dilution, leading to administration of supratherapeutic doses. We report three cases of postoperative macular edema and subretinal fluid following a standard dose of 1 mg/0.1 mL of cefuroxime at the end of cataract surgery. Distinguishing features of these cases were intraoperative zonular instability and history of vitrectomy. We hypothesize that certain factors may increase the risk of cefuroxime-associated retinal toxicity, including history of vitrectomy, zonular compromise, posterior capsular break, surgery for a secondary intraocular lens, and unicameral state. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:615-618.].

Toxicidad ocular tras sobredosificación accidental de cefuroxima intracameral en cirugía de catarata / Ocular toxicity after inadvertent overdose of intracameral cefuroxime during cataract surgery

Objetivo Describir los efectos de la inyección de cefuroxima intracameral a una dosis más alta de la recomendada en cirugía de catarata. Métodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo día que recibieron 12,5mg/0,1ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugía, por un error en la dilución. A todos los pacientes se les realizó un seguimiento oftalmológico estrecho durante 6 meses. Resultado Todos los pacientes presentaron una inflamación marcada del segmento anterior con edema corneal que se resolvió en todos los casos (entre 5 días y 3 meses). A los 6 meses de seguimiento se constató una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p=0,038), siendo<1000cels/mm2 en 3 casos. Tres pacientes (37,5%) presentaron un edema macular precoz, dejando como secuela permanente la disrupción de la capa elipsoidal a nivel subfoveal en uno de los casos. Uno de los pacientes desarrolló una neuropatía óptica con defecto pupilar aferente asociado. Conclusiones Aunque la inyección de cefuroxima en cámara anterior a dosis de 1mg/0,1ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificación puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior (AU)

Purpose To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. Methods Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5mg/0.1ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. Results All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P=.038), being<1000 cells/mm2 in 3 cases. Three patients (37.5%) showed early macular oedema, with subfoveal ellipsoid layer disruption in one case as a permanent sequel. One patient developed an optic neuropathy with associated afferent pupillary defect. Conclusions Although 1mg/0.1ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments (AU)

Effect of Intracameral Cefuroxime on Graft Endothelial Cells in Descemet Membrane Endothelial Keratoplasty: A Comparative Study.

Purpose: To evaluate the effect of intracameral cefuroxime on graft endothelial cell loss after simple Descemet Membrane Endothelial Keratoplasty (DMEK) and combined DMEK and cataract surgery.Materials and Methods: Single-center retrospective comparative analysis. One hundred and three patients were included, 31 in the cefuroxime group and 72 in the non-cefuroxime (NC) group. Best Spectacle-Corrected Visual Acuity (BSCVA), endothelial cell density (ECD) of the graft measured by specular microscopy, and the recipient's pachymetry were recorded pre-operatively and at 1, 3, and 6 months after surgery.Results: In the cefuroxime group, BSCVA was 0.22 ± 0.27 LogMAR, 0.15 ± 0.24 LogMAR and 0.07 ± 0.22, respectively, at 1, 3, and 6 months after surgery with no significant differences found when compared to the NC group (p > .05). Anatomical outcomes were similar as mean pachymetry decreased from 599 ± 51 µm preoperatively to 511 ± 30 µm at 6 months after surgery in the cefuroxime group and from 607 ± 67 µm preoperatively to 519 ± 32 µm at 6 months in the NC group (p = .25). Endothelial cell loss was comparable between both groups: 33.4% versus 33.6% at 1 month (p = .97), 37.4% versus 34.9% at 3 months (p = .68) and 41.6% versus 38.3% at 6 months (p = .42) in the cefuroxime and NC groups, respectively. The rates of rebubbling, graft rejection, and cystoid macular edema were not significantly higher in the cefuroxime group.Conclusion: The use of intracameral cefuroxime during simple or combined DMEK did not lead to higher graft endothelial cell loss.

Safety of intracameral cefuroxime in pars plana vitrectomy.

BACKGROUND/OBJECTIVES: Postoperative endophthalmitis is a rare, but serious complication of pars plana vitrectomy (PPV). Subconjunctival cefuroxime injection has been the traditional choice for post vitrectomy endophthalmitis prophylaxis. Its effectiveness and safety in this context are however poorly understood and cases of retinal toxicity have been reported. The traditional standard subconjunctival antibiotic prophylaxis has been superceded in cataract surgery by intracameral antibiotic prophylaxis. SUBJECTS/METHODS: The primary aim of this three centre non-randomised retrospective database cohort study of 7,532 PPV procedures was to identify the rate of endophthalmitis in cohorts of patients treated with intracameral or subconjunctival cefuroxime. A secondary aim was to estimate the achieved intraocular antibiotic concentrations of cefuroxime in eyes with intracameral versus subconjunctival administration using mathematical modelling. RESULTS: The overall incidence of postoperative endophthalmitis was 0.07% (5/7532). There were no cases of endophthalmitis in eyes receiving intracameral cefuroxime alone or in combination with subconjunctival cefuroxime (0/5586). Patients receiving subconjunctival cefuroxime alone had a higher incidence of endophthalmitis (0.22%, 4/1835), and there was one case of endophthalmitis in eyes not receiving any perioperative antibiotics (0.9%, 1/111). No cases of cefuroxime toxicity were identified. With subconjunctival cefuroxime, in the presence of a sclerotomy leak, we estimated the vitreous drug concentration to be higher than that for intracameral cefuroxime and potentially toxic. CONCLUSIONS: Intracameral cefuroxime appears to be a safe and efficient choice for prophylaxis against endophthalmitis after PPV. Small eyes with intraocular tamponade seem to be at particular risk of drug toxicity if cefuroxime is administered via the subconjunctival route.

Toxicities of and inflammatory responses to moxifloxacin, cefuroxime, and vancomycin on retinal vascular cells.

Prophylactic intracameral injection of antibiotics is commonly used to prevent endophthalmitis after cataract surgery. However, devastating visual complications have been reported including hemorrhagic occlusive retinal vasculitis (HORV).To determine the toxic and inflammatory effects of moxifloxacin, cefuroxime, and vancomycin on human retinal vascular cells, human retinal vascular endothelial cells (RVEC) and pericytes were exposed to three antibiotics, and the adverse effects were assessed by membrane damage, loss of intrinsic esterase activity, kinetic cell viability, and inflammatory cytokine secretion. Their retinal toxicity was examined by live/dead assays after an intravitreal injection of the three antibiotics into mice eyes. In vascular cells in culture, membrane damage and loss of esterase activity were induced after exposure to the three antibiotics. The toxic effects were most obvious after moxifloxacin (RVEC, ≥125 µg/mL; pericytes, ≥1000 µg/mL) at 24 h. Cefuroxime also reduced esterase activity and the membrane integrity of vascular cells but were less toxic than moxifloxacin. Kinetic cell viability testing showed that 500 µg/mL of moxifloxacin exposure induced significant decrease (29%) in the viability as early as 1 h. When the inflammatory effects of the antibiotics were examined, a significant induction of IL-8 was observed especially by RVECs after exposure to cefuroxime or vancomycin which was exacerbated by L-alanyl-γ-D-glutamyl-meso-diaminopimelic acid (Tri-DAP), a NOD1 ligand. Intravitreal injections in mice showed that cefuroxime and vancomycin caused retinal and vascular toxicity extending to the inner nuclear layers. Collectively, moxifloxacin causes immediate damage to retinal vascular cells in vitro, while cefuroxime and vancomycin induced significant inflammatory effects on vascular endothelial cells and caused retinal toxicity. Surgeons need to be cautious of the toxicity when antibiotics are used prophylactically especially by intravitreal administration.

Bronchiolitis Obliterans After Cefuroxime-Induced Stevens-Johnson Syndrome.

BACKGROUND Bronchiolitis obliterans is the term used to describe a clinical syndrome of irreversible airflow obstruction. Among the etiologies linked to this entity is the rarely reported association with Stevens-Johnson syndrome, which has had a poor outcome in most of the previously published cases. The optimum management of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome is not well defined. CASE REPORT A 41-year-old woman developed significant shortness of breath 3 months after recovering from Stevens-Johnson syndrome precipitated by a second-generation cephalosporin. She was found to have severe irreversible airway obstruction on physiology studies, and computed tomography scans of the inspiratory and expiratory phases of respiration showed air trapping that was more prominent on expiratory films. The patient was diagnosed with bronchiolitis obliterans, for which bronchodilators and long-term macrolide therapy were administered. Although she did not recover completely, her follow-up physiology studies showed that the bronchiolitis obliterans was stable. CONCLUSIONS Bronchiolitis obliterans secondary to Stevens-Johnson syndrome is a rare entity that is progressive and can lead to functional impairment. Identifying the disease at an early stage might stabilize or slow its progression. Herein, we describe a case of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome and review the literature to raise awareness of this condition, highlight its course, and discuss the available treatments.

Clinical Outcomes of Failing to Dose-Reduce Cephalosporin Antibiotics in Older Adults with CKD.

BACKGROUND AND OBJECTIVES: Current dosing recommendations for cephalosporin antibiotics are on the basis of pharmacokinetic studies and are frequently ignored in practice. This study was undertaken to investigate the clinical outcomes of failing to dose-reduce cephalosporin antibiotics in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective cohort study conducted in Ontario, Canada using linked population-based health care databases. Nine thousand three hundred forty-seven outpatients (median age 83; interquartile range, 77-88 years; 57% women) with an eGFR<30 ml/min per 1.73 m2 and no prior history of dialysis were dispensed oral cephalexin, cefuroxime, or cefprozil between April of 2007 and March of 2016. Two thirds of the patients (6253 of 9347) received a higher than recommended daily dose of cephalexin (>1000 mg), cefuroxime (>500 mg), or cefprozil (>500 mg). The primary outcome was a hospital encounter (emergency room visit or hospital admission) with a condition listed as a possible side-effect of cephalosporins. Secondary outcomes were antibiotic treatment failure and all-cause mortality. All measures were assessed in the 30 days after cephalosporin initiation. RESULTS: Patients who received a higher than recommended dose of a cephalosporin antibiotic were similar in multiple indicators of baseline health to patients who received a reduced dose. Overall, 6% of patients presented to hospital with a possible cephalosporin side-effect, 13% failed antibiotic treatment, and 3% died. Compared with a reduced dose, receiving a higher dose of antibiotic was not associated with a different rate of side-effects (adjusted odds ratio, 1.00; 95% confidence interval, 0.84 to 1.20), treatment failure (1.01; 0.88 to 1.15), or death (0.99; 0.76 to 1.29). CONCLUSIONS: In this study we failed to demonstrate any association between the dose of cephalosporin antibiotic administered to elderly patients with CKD and the risk of side-effects leading to hospitalization, treatment failure, or mortality.

OCULAR TOXICITY AFTER INADVERTENT INTRACAMERAL INJECTION OF HIGH DOSE OF CEFUROXIME DURING CATARACT SURGERY: A CASE SERIES.

PURPOSE: To report ocular side effects after inadvertent intracameral injection of a high dose of cefuroxime. METHODS: Nineteen eyes of 19 patients were seen in our eye department 1 week after the referring surgeon had injected an erroneous dose of intracameral cefuroxime (12.5 mg/0.1 mL in 14 patients, Group A, and 10 mg/0.1 mL in 5 patients, Group B) at the end of a cataract surgery. A complete ophthalmic examination was performed postoperatively. RESULTS: Eight patients (42.10%) exhibited ocular side effects. One patient (Group A) developed a noninfectious panuveitis. One case (Group B) had a serous macular detachment. Five patients (4 from Group A and 1 from Group B) showed a disruption of the ellipsoid layer with temporary/permanent drop in visual acuity. One patient presented with color alteration (Group A), but electrodiagnostic studies did not reveal any significant alterations. CONCLUSION: Anterior and posterior inflammation has been described after intracameral injection of high dose of cefuroxime. In this study, 10 mg to 12.5 mg of intracameral cefuroxime is shown to be, principally, toxic to the retina with transient or permanent retinal changes on optical coherence tomography which correlate with visual outcomes postoperatively. Protocols to avoid dilution errors should be available in theaters during cataract surgery where such commercial preparations are not available.

Cefuroxime-induced anaphylaxis with prominent central nervous system manifestations: A case report.

Cefuroxime is a second-generation cephalosporin antibiotic that causes immediate hypersensitivity reactions, ranging from mild urticaria to severe anaphylactic shock. Anaphylactic reactions typically involve multiple systems, most notably, the skin and the respiratory and cardiovascular systems. Here, we report the unusual case of a patient who presented with oral cefuroxime-induced anaphylaxis with prominent neurologic manifestations. To identify the drug responsible for the anaphylaxis, we performed skin tests. Based on positive skin-prick test results, the diagnosis of cefuroxime-induced anaphylaxis was confirmed. Therefore, we suggest that clinicians should consider the possibility of a drug-induced anaphylactic reaction when neurologic but not cutaneous symptoms are present. The skin-prick test is a safe and useful diagnostic tool to confirm this kind of immediate drug hypersensitivity.

Periprocedural antibiotic treatment in transvascular aortic valve replacement.

BACKGROUND: To date, there are no guidelines recommending a specific prophylactic antibiotic treatment in transcatheter aortic valve replacement (TAVR). The aim of this study is to evaluate clinical data after TAVR with different periprocedural antibiotic regimens. METHODS: In May 2015 the institutional rules for periprocedural antibiotic prophylaxis were changed from 3 days to 1 day. Thus, a total of 450 consecutive TAVR patients between February 2014 and June 2016 were classified into two intention-to-treat groups: patients receiving a 1-day Cefuroxime prophylaxis (N = 225); patients receiving a 3-day Cefuroxime prophylaxis (N = 225). RESULTS: One-day Cefuroxime regimen was not associated with shorter hospitalization (3-day Cefuroxime 9 ± 4.7 vs 1-day Cefuroxime 8.9 ± 4.0; P = 0.87). Incidence of diarrhea (26.2% vs 18.2%; P = 0.04) and Clostridium difficile infections (4% vs 0.4%; P = 0.01) were significantly higher in the 3-day group. No endocarditis was registered after 1 year follow-up. There was no difference in 30-day overall mortality rate, major vascular complications, bleeding complications, pacemaker-implantation rate, paravalvular regurgitation, or acute kidney injury between patients groups. CONCLUSION: Three-day Cefuroxime prophylaxis does not seem to be advantageous compared to a shorter 1-day regimen, but even shows a significantly higher incidence of diarrhea and Clostridium difficile infection.