Compounding errors caused recent outbreak of bevacizumab-related endophthalmitis

This retrospective review reports on an endophthalmitis outbreak associated with intravitreal injection of bevacizumab in south Florida. It determined that the outbreak was caused by compounding procedures used to prepare the syringes containing the bevacizumab, not the drug or injection technique.

All 12 cases in this review occurred between July 5 and July 8, 2011 at four different locations in south Florida. All patients received bevacizumab prepared by the same compounding pharmacy. Microbiology cultures for 10 patients were positive for Streptococcus mitis/oralis. Seven unused syringes prepared by the compounding pharmacy at the same time of the outbreak were also positive for S. mitis/oralis.

Unfortunately, final visual outcome in these patients was poor. After four months of follow-up, all but one patient had count fingers or worse visual acuity and three required evisceration or enucleation.

An accompanying editorial also implicates compounding errors in clusters of outbreaks occurring over six years of intraocular bevacizumab use, both inside the U.S. and out.

"Noncompliance with recognized standards and poor aseptic technique are the most likely causes of these outbreaks. The key to preventing these catastrophic occurrences depends on the implementation of and strict adherence to United States Pharmacopoeia Chapter 797 requirements."

The perspective also describes the appropriate method for fractionating bevacizumab into syringes for intravitreal injection, with specific recommendations to prevent such outbreaks.