Characteristics and Outcomes of Endogenous Endophthalmitis

Modjtahedi, Bobeck S.; Finn, Arthur L.; Barb, Scott; MacLachlan, Matthew; Zyl, Tavé van; Papakostas, Thanos D.; Eliott, Dean

doi:10.1016/j.oret.2018.08.009

Cited by 30 publications

(24 citation statements)

References 26 publications

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“…In North America and Europe, EE is caused primarily by gram-positive and fungal species, 1,6,7,10 -12 and the present study revealed similar findings; 56% and 29% of eyes with EE seen at our institution had gram-positive and fungal etiologies, respectively. On the other hand, EE in Asian countries is predominantly due to gram-negative species, 2,15 possibly because of the higher incidence of hepatobiliary pathology, which tends to be gram-negative in nature.…”

Section: Discussionsupporting

confidence: 84%

“…A hypopyon was observed at presentation in 50% of our patients, which is higher than the 24% to 31% described in similar reports. 6,10 In our series, eyes with gram-positive infections were significantly more likely to present with hypopyon than eyes with fungal or gram-negative infections.…”

Section: Discussionmentioning

confidence: 49%

“…This is in contrast to the series of Modjtahedi et al in which no eyes that underwent initial PPV required a second PPV as opposed to 55% of eyes that initially underwent bedside intravitreal antibiotics. 6 There were baseline differences in the populations between these 2 series that may underlie these different results, including a smaller number of eyes in our series. Different distributions of microbial etiologies, for example, might underlie the different outcomes.…”

Section: Discussionmentioning

confidence: 74%

“…Regarding visual prognosis, the literature shows mixed results. Modjtahedi et al, 6 in their series of patients with EE, demonstrated no difference between mean presenting VA and mean VA at week 2 and month 2 but did find a significant difference between mean presenting VA and mean VA at week 1 and month 6. They noted a 2-line or greater improvement in VA in 65% of their patients.…”

Section: Discussionmentioning

confidence: 86%

“…Predisposing conditions include immunosuppression, diabetes, endocarditis, and intravenous drug use (IVDU), among others. 1 -15 The causative agent varies worldwide, with gram-positive and fungal etiologies more common in North America and Europe 1,5 -8,10 -14 and gram-negative species more typical in Asia. 2,9,15 Population-based reports suggest an incidence of 0.04% to 0.4% for septicemic patients.…”

Section: Introductionmentioning

confidence: 99%

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Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes

Budoff

Zarbin

Bhagat

2020

Journal of VitreoRetinal Diseases

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Purpose: This work describes the characteristics, treatment, and outcomes of endogenous endophthalmitis (EE) cases over 13 years at a tertiary care hospital. Methods: This retrospective case series included EE cases from 2006 to 2018. Eyes were categorized by cultured organism and initial treatment status. Results: Forty-five eyes of 38 patients were identified with EE. Mean age was 48 ± 12 years and approximately three-fourths were male. Mean visual acuity (VA) at presentation was logMAR 1.86 ± 0.83. More than 50% of patients had a history of intravenous drug use. In a quarter of patients, no systemic source of infection was identified; 90% of these patients had a history of intravenous drug use. Bilateral infections occurred in 18% of participants. Of positive cultures, 29%, 56%, and 13% were fungal, gram-positive, and gram-negative in etiology, respectively. Eyes with fungal infections had a better presenting VA and were more likely to have better than 20/100 final VA vs those with bacterial infections. All patients received IV antibiotics; additionally 29% of eyes underwent initial combined pars plana vitrectomy with intravitreal antibiotic injection while 51% of eyes initially received bedside intravitreal antibiotic injection. There was no significant difference in final VA with respect to initial mode of treatment. Conclusions: Initial treatment of intravitreal antibiotics with or without pars plana vitrectomy did not show any difference in the average final VA in eyes with EE. Eyes with fungal infections had more favorable visual outcomes than those with bacterial infections. Almost 1 in 5 EE eyes were enucleated.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes

Budoff

Zarbin

Bhagat

2020

Journal of VitreoRetinal Diseases

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Incidence of Drug Use–Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016

et al. 2021

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IMPORTANCEComplications arising from the nationwide opioid epidemic led to an increase in health care use. Few studies have investigated whether this is reflected in hospital admissions for endogenous endophthalmitis. OBJECTIVE To report changing trends in epidemiology, risk factors, hospital course, and costs associated with drug use-related endogenous endophthalmitis hospitalizations in the United States from 2003 to 2016. DESIGN, SETTING, AND PARTICIPANTS Nationwide, retrospective cross-sectional study using the National Inpatient Sample. A total of 56 839 patients admitted with a diagnosis of endogenous endophthalmitis were included. Data were analyzed between 2003 and 2016. EXPOSURES Inpatient admission for endogenous endophthalmitis during the years 2003 to 2016. MAIN OUTCOMES AND MEASURESThe Nationwide Inpatient Sample was queried to identify all inpatient admissions with a diagnosis of endogenous endophthalmitis in the United States between the years 2003 and 2016. Analyses were performed 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. Median and cumulative inflation-adjusted costs for admissions were calculated.RESULTS Of all patients, 55.6% were White, 13.6% were Black, and 10.6% were Hispanic. There were an estimated 56 839 endogenous endophthalmitis-related hospitalizations; 13.7% of these patients (n = 7783) had a history of drug dependence or use. The drug-using population was significantly younger (49.6 vs 57.5 years; difference, 7.9; 95% CI, 6.93-8.88; P < .001) and more likely to be male (61.8% [n = 35 127] vs 49.0% [n = 21 712]; difference, 12.8%; 95% CI, 11.6%-14.0%; P < .001). The incidence of endogenous endophthalmitis associated with drug dependence or use increased from 0.08 per 100 000 in 2003 to 0.32 per 100 000 population in 2016 across all 4 US geographic regions.CONCLUSIONS AND RELEVANCE 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. 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.

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Endogenous Endophthalmitis

Berry

Yeh

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Characteristics and Outcomes of Endogenous Endophthalmitis

Cited by 30 publications

References 26 publications

Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes

Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes

Incidence of Drug Use–Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016

Endogenous Endophthalmitis

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