Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment

Abstract

Background Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or resistance is an important clinical issue worldwide. Purpose To review the published literature on endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance. Methods The data were analysed from a PubMed search of endophthalmitis cases caused by Gram-positive organisms with reported reduced vancomycin susceptibility and/or vancomycin resistance from 1990 to 2015. Results From 18 publications identified, a total of 27 endophthalmitis cases caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance were identified. The aetiologies of endophthalmitis were exogenous in 19/27 cases (11 post-cataract surgery, 2 post-penetrating keratoplasty, 1 post-glaucoma surgery, 4 post-open globe injury, 1 post-intravitreal injection of ranibizumab), and endogenous in 4/24 cases; no details were available about the four remaining patients. The causative organisms included Enterococcus species (7/27), coagulase-negative staphylococci (4/27), Staphylococcus aureus (4/27), Bacillus species (4/27), Streptococcus species (3/27), Leuconostoc species (3/27), Staphylococcus hominis (1/27), and unidentified Gram-positive cocci (1/27). Visual acuity of 20/400 or better at the final follow-up was recorded in 10/26 patients (38.5%; data were not available for one patient). Treatment options include fluoroquinolones, penicillin, cephalosporins, tetracyclines, and oxazolidinones. Conclusions In the current study, visual acuity outcomes were generally poor. Enterococcus and Staphylococcus species were the most common organisms reported and postoperative endophthalmitis after cataract surgery was the most common clinical setting.

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

“…There are few reports of vancomycin resistant GP bacteria in endophthalmitis 3 . Given the increasing concern with the emergence of vancomycin resistance in systemic bacterial infections, using an antibiotic combination where both antibiotics are effective against GP isolates would be beneficial and may indeed become a factor in determining the choice of the 2 nd antibiotic.…”

Emerging Worldwide Antimicrobial Resistance, Antibiotic Stewardship and Alternative Intravitreal Agents for the Treatment of Endophthalmitis

“…However, a more recent PubMed-based data review (1990-2015) reported 27 cases of endophthalmitis caused by gram-positive organisms with reduced vancomycin susceptibility or vancomycin resistance. 8 Visual acuity outcomes were generally poor in these cases. A visual acuity of 20/400 or better at the final follow-up was reported in 10/26 patients (38.5%, data not available for one patient).…”

“…A visual acuity of 20/400 or better at the final follow-up was reported in 10/26 patients (38.5%, data not available for one patient). 8 …”

Mortality after endophthalmitis following contemporary phacoemulsification cataract surgery

“…Relhan et al . have recently reviewed all cases of endophthalmitis caused by gram‐positive organisms with reduced vancomycin susceptibility and highlighted both favourable and unfavourable outcomes in terms of function . Re‐examining the 18 studies referred to in that survey, patients with post‐cataract endophthalmitis did not show any increased mortality, suggesting vancomycin‐resistant organisms are not an indicator of life expectancy outcome.…”