Endophthalmitis after open globe injuries: changes in microbiological spectrum and isolate susceptibility patterns over 14 years

Abstract

BackgroundThe objective of this study was to evaluate the microbiologic spectrum and antimicrobial susceptibility of isolates in post-traumatic endophthalmitis and compare with our earlier published report. A retrospective review was conducted on 581 consecutive patients with culture-proven post-traumatic endophthalmitis at L. V. Prasad Eye Institute, India, from January 2006 to March 2013.FindingsA total of 620 isolates from 581 patients were identified (565 bacteria and 55 fungi). The most common isolate was Bacillus spp. (106/620, 17.1%) closely followed by Streptococcus pneumoniae (105/620, 16.9%), and coagulase-negative Staphylococci (97/620, 15.6%). In our earlier report, the commonest bacteria included Streptococcus spp. (30/139, 21.6%) and gram-positive coagulase-negative micrococci (26/139, 18.7%). Gram-positive isolates were usually susceptible to vancomycin (98.2%). Gram-negative isolates were generally susceptible to gatifloxacin (92.9%), ofloxacin (89.4%), chloramphenicol (88.6%, Pseudomonas isolates were often resistant), amikacin (83.5%), and ceftazidime (77.2%). Fourteen years ago, the most sensitive antibiotic was ciprofloxacin for both gram-positive bacteria (95.12%) and gram-negative bacteria (100%).ConclusionsThe microbiological spectrum of post-traumatic endophthalmitis has remained unchanged over the last 14 years, and Bacillus spp. continues as the most common infecting organism. Vancomycin is the drug of choice for empiric coverage of gram-positive bacteria. Susceptibility of gram-negative bacteria to commonly used antimicrobials (amikacin and ciprofloxacin) has decreased by 10% - 15% and to ceftazidime has increased by 10.5%.

Microbiological Isolates and Antibiotic Susceptibilities: A 10-Year Review of Culture-Proven Endophthalmitis Cases

“…16 The relatively higher frequency of fungi might be associated with open-globe injuries involving vegetable matter or soil contamination due to the mild and moist climate in our series. 17 There was also a relatively high incidence of B. cereus, which is known to be highly virulent and to cause rapid progression to panophthalmitis, [18][19][20] which might be associated with open-globe injuries with intraocular foreign bodies, particularly metal objects and the variety of trauma causes in our series. To optimize the prevention of endophthalmitis using prophylactic antibiotics, it is imperative to understand which antimicrobial regimen will be effective against the possible causative organisms.…”

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?

“…Jindal et al have reported 32/65 (49 %) GNB isolates from patients with acute onset post-operative endophthalmitis are resistant to ceftazidime [15]. The same groups of authors have reported 22 % of GNB isolated from patients with open globe injuries are resistant to ceftazidime [16]. Anand et al reported 38 % of GNB isolates from patients with post-operative endophthalmitis are resistant to ceftazidime [17].…”

Endophthalmitis: state of the art

“… 108 , 109 Gram-positive cocci are the more common isolates among bacteria, followed by Gram-positive bacilli and other Gram-negative organisms. 108 , 109 Among Gram-positive cocci, coagulase-negative Staphylococcal organisms (ie, S. epidermidis and Staphyloccoccus saprophyticus ) along with Streptococcus species are the predominant groups. Gram-positive Bacillus species have been commonly reported in culture isolates of posttraumatic endophthalmitis.…”