Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades

Yannuzzi, Nicolas A.; Si, Nancy; Relhan, Nidhi; Kuriyan, Ajay E.; Albini, Thomas A.; Berrocal, Audina M.; Davis, Janet L.; Smiddy, William E.; Townsend, Justin H.; Miller, Darlene; Flynn, Harry W.

doi:10.1016/j.ajo.2016.11.006

Cited by 55 publications

(59 citation statements)

References 13 publications

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“…Similar to prior studies, vancomycin was effective against all 45 isolates in this study, and it remains one of the most effective empiric treatments for endophthalmitis [5,6,9,10,24]. However, delafloxacin has the benefit of wider microbial coverage including Gram-negative organisms like P. aeruginosa, anaerobes, and atypical infections [25,26].…”

Section: Discussionsupporting

confidence: 81%

“…The most common microbes causing exogenous endophthalmitis are Gram-positive cocci, namely CoNS as well as S. aureus [1,2,5,13]. In the Endophthalmitis Vitrectomy Study as well as some more recent studies, CoNS and S. aureus have remained at similar post-operative prevalence rates following cataract surgery through the decades (approximately 60% and 10%, respectively) [6,10,13]. Occurring at a rate of 0.056%, endophthalmitis after intravitreal injection is the second most common category of endophthalmitis, with CoNS comprising 38% of cases, followed by Streptococcus species and S. aureus [2].…”

Section: Discussionmentioning

confidence: 99%

“…Current empiric treatment of suspected bacterial endophthalmitis typically begins with intravitreal vancomycin and ceftazidime [1,6,[14][15][16]. Regarding fluoroquinolones, intracameral and systemic treatment has gained interest in light of the favorable safety profile and low MIC levels of some agents like moxifloxacin [15,17].…”

Section: Discussionmentioning

confidence: 99%

“…Other less common etiologies include post-injection and post-traumatic endophthalmitis [1,2]. Across these mechanisms of infection, the most common causative organism is coagulase-negative Staphylococcus (CoNS) [1][2][3][4][5][6]. Prior studies have established high rates of antibiotic resistance in Gram-positive endophthalmitis vitreous isolates, with resistance to fluoroquinolones including ciprofloxacin and levofloxacin as high as 41% and 56%, respectively [5,7,8].…”

Section: Introductionmentioning

confidence: 99%

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In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Fan

Lin

Yannuzzi

et al. 2020

J Ophthal Inflamm Infect

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Background: To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues. Methods: Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin). Results: Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL. Conclusion: Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Fan

Lin

Yannuzzi

et al. 2020

J Ophthal Inflamm Infect

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“…Coagulase negative Staphylococci (CNS) are gram positive organisms that represent a common cause of bacterial endophthalmitis and have been isolated in as many as 62% of vitreous samples after cataract surgery or intraocular lens (IOL) exchange. 1 , 2 The most frequently isolated CNS species from acute-onset endophthalmitis vitreous biopsy samples are Staphylococcus epidermidis (81.9%) and Staphylococcus lugdunensis (5.9%). 3 Several investigations of patients with endophthalmitis caused by S. lugdunensis have been reported following cataract surgery and intravitreal injections.…”

Section: Introductionmentioning

confidence: 99%

Acute-onset endophthalmitis caused by Staphylococcus lugdunensis

Garoon

Miller

Flynn

2018

American Journal of Ophthalmology Case Reports

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PurposeTo report a series of patients with acute-onset bacterial endophthalmitis caused by culture proven Staphylococcus lugdunensis, and to characterize clinical outcomes and microbiologic susceptibilities of this organism.ObservationsThe study included six eyes of 6 patients. The etiologies included cataract surgery (3), open globe injury (2), and intravitreal injection (1). Isolates of S. lugdunensis demonstrated sensitivity to vancomycin in all cases reported. Three of 6 isolates of S. lugdunensis demonstrated resistance to oxacillin and 1 isolate demonstrated resistance to ciprofloxacin. Best-corrected visual acuity was ≥20/400 in 6/6 (100%) of eyes and ≥20/40 in 3/6 (50%) of cases.Conclusion and importanceAcute-onset endophthalmitis caused by S. lugdunensis is associated with variable visual outcomes. Vancomycin provides consistent coverage of acute-onset endophthalmitis cause by S. lugdunensis.

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Endophthalmitis Rates and Types of Treatments After Intraocular Procedures

VanderBeek,

Chen,

Tomaiuolo

et al. 2024

JAMA Ophthalmol

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ImportanceLong-term trend analyses of overall endophthalmitis rates and treatment patterns are scarce. It is also unknown if the deviation from the recommendations of the Endophthalmitis Vitrectomy Study toward decreased utilization of vitrectomy is associated with different vision outcomes.ObjectiveTo determine whether the rate of endophthalmitis after intraocular procedures or the primary treatment (prompt vitrectomy vs tap and inject) for endophthalmitis has changed over the past 20 years.Design, Setting, and ParticipantsThis cohort study examined data for cohorts created by querying for different intraocular procedures, including intravitreal injections and surgeries for cataract removal, glaucoma, retinal conditions, and corneal transplants from 2000 to 2022. The data source was a US administrative medical claims database comprising commercial and Medicare Advantage insurance plans. Any intraocular procedure with at least 6 months of data available before and 6 weeks after the procedure was eligible. Exclusion criteria consisted of any previous diagnosis of endophthalmitis or another intraocular procedure during the follow-up period.Main Outcome MeasureThe main outcomes were rate of postprocedure endophthalmitis and relative rate of prompt vitrectomy (vs tap and inject) as the primary method of treatment.ResultsAmong 2 124 964 patients, the mean (SD) age was 71.4 (10.2) years; 1 230 320 were female and 894 414 male. Over 22 years, 5 827 809 intraocular procedures were analyzed with 4305 cases of endophthalmitis found for an overall endophthalmitis rate of 0.07%. The yearly rate of endophthalmitis varied but generally declined from a high of 7 cases per 3502 procedures (0.20%) in 2000 to a low of 163 cases per 332 159 procedures (0.05%) in 2022. The percentage of cases treated with prompt vitrectomy also varied but generally declined over time with a high of 17 of 35 (48.6%) in 2003 and a low of 60 of 515 (11.6%) in 2021. Multivariable analysis of the endophthalmitis incidence rate ratio (IRR) showed a per-year decrease of 2.7% (IRR, 0.97; 95% CI, 0.97-0.98; P &lt; .001) over the study period. A similar analysis also showed that the incidence rate of prompt surgical treatment decreased by 3.8% per year throughout the study period (IRR, 0.96; 95% CI, 0.95-0.97; P &lt; .001).Conclusions and RelevanceThis study found that the incidence of endophthalmitis following intraocular procedures appears to have decreased substantially over the past 20 years while prompt vitrectomy is being used less frequently as primary treatment than in the past.

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Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades

Abstract: Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones.

Cited by 55 publications

References 13 publications

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Acute-onset endophthalmitis caused by Staphylococcus lugdunensis

Endophthalmitis Rates and Types of Treatments After Intraocular Procedures

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