Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies

Banker, Tanuj; McClellan, Andrew J.; Wilson, Benjamin David; Juan, Fabiana; Kuriyan, Ajay E.; Relhan, Nidhi; Chen, Felix V.; Weichel, Eric D.; Albini, Thomas A.; Berrocal, Audina M.; Sridhar, Jay; Gregori, Ninel Z.; Townsend, Justin H.; Flynn, Harry W.

doi:10.3928/23258160-20170802-05

Cited by 23 publications

(26 citation statements)

References 33 publications

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“…Intraocular antibiotics has been shown by metaanalysis to reduce the risk of traumatic endophthalmitis [20]. While several centers routinely use prophylactic systemic antibiotics [5,21,22], their use is controversial without strong supporting evidence [7]. Intravenous antibiotics were not advantageous over oral prophylaxis in a randomized controlled trial [6]; however, systemic antibiotics have not been compared with local administration in a similar fashion.…”

Section: Discussionmentioning

confidence: 99%

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Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

Drumright

Regan

Lin

et al. 2020

J Ophthal Inflamm Infect

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Background: Endophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair. Results: Institutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair. Conclusions: Despite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

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Section: Discussionmentioning

confidence: 99%

“…Endophthalmitis is a potentially devastating sequela of open globe injury. Rates of endophthalmitis after severe ocular trauma range from 0 to 17% [2,3], with a higher risk in the presence of an intraocular foreign body (IOFB) [4,5]. Outcomes are typically worse than post-operative endophthalmitis [2].…”

Section: Introductionmentioning

confidence: 99%

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

Drumright

Regan

Lin

et al. 2020

J Ophthal Inflamm Infect

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“…Many studies have described series of posttraumatic endophthalmitis and the distribution of isolates worldwide [1,6,10,11]. ese studies showed that the susceptibilities of microbiological isolates and infectious agents to particular antibiotics varied over time and differed according to regional variability, population, and ethnicity [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Endophthalmitis is a devastating clinical condition that can lead to severe visual loss. [1][2][3][4] Previous research reported that the incidence rate of infectious endophthalmitis following intraocular foreign body (IOFB) injuries ranged from 6.9-30% [5]. IOFB injuries were reported in 43% of posttraumatic endophthalmitis cases [6].…”

Section: Introductionmentioning

confidence: 99%

Microbiological Isolates and Antibiotic Susceptibilities in Cases of Posttraumatic Endophthalmitis: A 15-Year Review

Liu

Wang

et al. 2020

Journal of Ophthalmology

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Purpose. The objective of this study was to evaluate the microbiological spectrum and antibiotic susceptibilities of isolates in posttraumatic endophthalmitis over a 15-year period. Methods. A retrospective study of 3,163 posttraumatic endophthalmitis cases was conducted between July 2004 and July 2019. The outcome measures included the microbiological spectrum and antibiotic susceptibilities. Chi-squared tests were conducted to detect trends in changes in antibiotic sensitivity over the 15-year period. P values of <0.05 were considered statistically significant. Results. Of the 3,163 cases of posttraumatic endophthalmitis, 1,003 culture-positive isolates were identified. Among these, there were 848 (84.5%) Gram-positive isolates, 109 (10.9%) Gram-negative isolates, and 46 (4.6%) fungal isolates. The most common isolates were Staphylococcal species. There was a significant increase in the percentage of fungal isolates over the 15-year period (P=0.02). Gram-positive organisms showed the greatest level of susceptibility to vancomycin (99.6%). The susceptibilities of the 109 Gram-negative isolated organisms were as follows: levofloxacin (95.8%), meropenem (95.7%), ciprofloxacin (93.5%), tobramycin (90.8%), imipenem (88.9%), trimethoprim-sulfamethoxazole (TMP-SMX) (87.7%), ertapenem (80%), and ceftazidime (79.1%). The susceptibility of Gram-positive organisms to several antibiotics, including levofloxacin (P=0.004), ciprofloxacin (P<0.001), and chloramphenicol (P=0.001) decreased over time, whereas the susceptibility to TMP-SMX increased over time (P<0.001). The susceptibility of Gram-negative bacilli to ceftazidime decreased over time (P=0.03). Conclusions. Over the 15-year study period, most isolates were Gram-positive cocci, especially coagulase-negative staphylococci (CNS). Vancomycin seemed to be the most effective antibiotic for Gram-positive bacteria. Gram-negative bacteria appeared to be most susceptible to fluoroquinolones. A number of antibiotics showed an increasing trend of microbial resistance.

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“…Trauma accounts for up to 25–30′ of infectious endophthalmitis [7]. In reported large series, the incidence of endophthalmitis after open globe injury generally ranges from 3 to 5′ [11, 12, 13, 14, 15, 16, 17, 18, 19] and may be higher in the setting of soil contamination [20]. As O. turbata is found in soil and grass cuttings [21], this patient demonstrates that atypical organisms must be considered in chronic, indolent endophthalmitis when the infection source is known to be organic matter [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Post-Traumatic Endophthalmitis Caused by <b><i>Oerskovia turbata</i></b>

Rohowetz

Patel²,

Yannuzzi³

et al. 2019

Case Rep Ophthalmol

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Purpose: To present a previously unreported cause of bacterial endophthalmitis manifesting as delayed post-traumatic endophthalmitis ultimately responsive to total capsulectomy. Case Report: A patient presented with chronic endophthalmitis that occurred after ocular trauma with organic material and Oerskovia turbata was eventually isolated. After a prolonged treatment course, including two pars plana vitrectomies and total capsulectomy, the patient achieved 20/80 visual acuity at 1-year follow-up. Conclusion: This is the first reported patient with endophthalmitis due to O. turbata, a Gram-positive bacillus found in soil that rarely causes human infection. The infection had a delayed presentation despite early prophylactic antibiotics and was ultimately eliminated with total capsulectomy. Removal of lens and lens capsule may be necessary in the management of post-traumatic endophthalmitis unresponsive to more conservative therapy, particularly in cases involving atypical organisms and lens capsule violation.

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Culture-Positive Endophthalmitis After Open Globe Injuries With and Without Retained Intraocular Foreign Bodies

Abstract: Culture-positive endophthalmitis was identified after OGIs more often in eyes with a concurrent IOFB. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:632-637.].

Cited by 23 publications

References 33 publications

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

Microbiological Isolates and Antibiotic Susceptibilities in Cases of Posttraumatic Endophthalmitis: A 15-Year Review

Post-Traumatic Endophthalmitis Caused by <b><i>Oerskovia turbata</i></b>

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