Clinical and Microbiologic Review of Culture-Proven Endophthalmitis Caused by Multidrug-Resistant Bacteria in Patients Seen at a Tertiary Eye Care Center in Southern India

Pathengay, Avinash; Moreker, Mayur R; Puthussery, Rajesh; Ambatipudi, Srinivas; Jalali, Subhadra; Majji, Ajit B; Mathai, Annie; Husssain, Nazimul; Dave, Vivek Pravin; Sharma, Savitri; Das, Taraprasad

doi:10.1097/iae.0b013e31820f4b9d

Cited by 46 publications

(38 citation statements)

References 20 publications

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“…Multidrug resistance is more common in Gram-negative bacteria (78.6%) compared to Gram-positive bacteria (21.4%) [33]. The multidrug resistance and higher number of Pseudomonas in the current study may explain the poorer outcome in this study as compared to EVS.…”

Section: Resultsmentioning

confidence: 71%

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Jindal

Pathengay

Khera

et al. 2013

J Ophthal Inflamm Infect

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BackgroundThe purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.ResultsSixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients.ConclusionIn the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

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Section: Resultsmentioning

confidence: 71%

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Jindal

Pathengay

Khera

et al. 2013

J Ophthal Inflamm Infect

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“…Delay in treatment results in partial or complete loss of vision and patients are treated empirically with a combination of vancomycin and ceftazidime intravitreal injection to cover both Gram positive and Gram negative bacteria (GNB) [1,2]. There are several reports on bacterial resistance to ceftazidime and vancomycin in isolates from systemic infection [3,4] and very few studies on bacterial resistance to ceftazidime and vancomycin in patients with endophthalmitis [5,6]. In this report, we have studied the susceptibility of bacterial isolates from patients with endophthalmitis to vancomycin and ceftazidime.…”

Section: Introductionmentioning

confidence: 99%

Susceptibility of bacterial isolates to vancomycin and ceftazidime from patients with endophthalmitis: Is there a need to change the empirical therapy in suspected bacterial endophthalmitis?

Reddy¹,

Reddy²,

Paruvelli³

et al. 2014

Int Ophthalmol

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To review the susceptibility of bacterial isolates to ceftazidime and vancomycin isolated from patients with endophthalmitis. Microbiology records of patients with endophthalmitis between June 2010 and May 2013 were reviewed. Vitreous and AC fluids obtained from patients with endophthalmitis were subjected to direct microscopy examination and culture. Antibiotic susceptibility of the isolates was performed by Kirby Bauer disk diffusion method. Resistant to ceftazidime in Gram negative bacteria (GNB) by disk diffusion method is confirmed by minimum inhibitory concentration using E test. Culture was positive for bacteria/Fungi in 224/356 patients (62.9 %). Out of 224 patients, 191 (85.2 %) patients showed bacterial growth and 33 (14.0 %) showed fungal growth. Mixed bacterial infection was seen in five patients. Among the GNB, 23/123 (18 %) of the isolates were resistant to ceftazidime, and all the Gram positive bacteria 73/73 (100 %) were susceptible to vancomycin. Sixteen of 123 (13 %) GNB were resistant to amikacin. Although there is an increase in resistance to ceftazidime compared to amikacin in GNB, amikacin intravitreal injection is associated with macular toxicity and no single antibiotic has full coverage for all GNB. Combination of vancomycin and ceftazidime empiric therapy can be continued in patients with suspected endophthalmitis and treatment is modified based on clinical response and susceptibility results.

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“…The more common Gram-negative organisms causing endophthalmitis include species of Pseudomonas , Haemophilus , Proteus , and Klebsiella . There have been reports of multidrug-resistant strains of Gram-negative bacteria being isolated from patients with endophthalmitis 4. Endophthalmitis caused by Klebsiella pneumoniae is associated with generally poor visual outcomes, despite treatment with appropriate antibiotics 5.…”

Section: Introductionmentioning

confidence: 99%

Acute-onset postoperative endophthalmitis caused by multidrug-resistant Klebsiella pneumoniae

Sanghi¹,

Pathengay²,

Jindal³

et al. 2014

OPTH

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The purpose of this paper is to report outcomes of intravitreal imipenem in the treatment of multidrug-resistant Klebsiella-related postoperative endophthalmitis. This observational case series consists of three eyes from three patients seen between 2013 and 2014. Multidrug-resistant Klebsiella pneumoniae is characterized by a rapid, fulminant course and severe intraocular inflammation. Intravitreal imipenem may be used to treat such infection.

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Clinical and Microbiologic Review of Culture-Proven Endophthalmitis Caused by Multidrug-Resistant Bacteria in Patients Seen at a Tertiary Eye Care Center in Southern India

Abstract: Gram-negative bacteria, chiefly Pseudomonas, are the most common multidrug-resistant organisms, and the outcome is usually poor. Emergence of multidrug-resistant bacteria is a matter of concern. A new alternative group of drugs may be considered for the management of these isolated cases.

Cited by 46 publications

References 20 publications

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Susceptibility of bacterial isolates to vancomycin and ceftazidime from patients with endophthalmitis: Is there a need to change the empirical therapy in suspected bacterial endophthalmitis?

Acute-onset postoperative endophthalmitis caused by multidrug-resistant Klebsiella pneumoniae

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