Factors Associated With Positive Microbial Culture in Patients With Endophthalmitis Based on Clinical Presentation and Multimodal Intraocular Sampling

Abstract

Purpose: The aim of this study was to identify the factors associated with positive culture sample in patients with endophthalmitis based on clinical presentation and multimodal intraocular sampling. Design: Retrospective review. Methods: A total of 259 subjects with a diagnosis of endophthalmitis presented to a tertiary ophthalmic referral center between 2006 and 2018. Patient demographics, presenting clinical findings and the results of aqueous and vitreous sampling were analyzed. Results: Mean age was 64.2 (± 22.6) years with 52.9% female. Endophthalmitis followed cataract surgery in 84 eyes (32.4%) and was the most common precipitant; intravitreal injections were the next common cause involving 60 eyes (23.2%). Mean visual acuity on presentation was hand movements with a hypopyon present 134 eyes (52%). In total, 135 cases (52.1%) were culture positive. Aqueous sampling was performed in 112 eyes [culture positive 36 (32.1%)]; vitreous sample in 122 eyes [positive in 56 (45.3%)]. Vitrectomy was performed in 169 eyes with 149 sent for culture [70 (47.0%) positive]. A positive vitrectomy culture was observed in 14 eyes (36.9%) of 38, despite initial treatment with intravitreal antibiotics. Factors associated with positive culture were aqueous tap [odds ratio (OR) 2.06, P = 0.02], vitrectomy (OR 2.86, P = 0.001), and absent red reflex (OR 2.73, P = 0.001). Conclusions: A multimodal approach to intraocular sampling should be considered in those presenting with endophthalmitis, with both aqueous tap and vitrectomy associated with an increased probability of achieving a positive culture.

Nanopore techniques as a potent tool in the diagnosis and treatment of endophthalmitis: a literature review

“…Moreover, whether a sample is positively-cultured is related to many factors, such as the clinical characteristics of the patient, the sampling sites as well as laboratory facilities. Studies indicate that both aqueous tap and vitrectomy can increase the possibility of obtaining a positive culture [26] . Culture media also poses influences to culture results [27][28][29] .…”

“…Culture media also poses influences to culture results [27][28][29] . We summarized the sequencing and culture results of clinically suspected endophthalmitis in Table 1 [4,20,23,26, . Due to the low and varied culture rate and the small amount of intraocular fluid samples, rapid and accurate diagnosis of acute endophthalmitis is very important and closely related to the degree of visual loss of the patient.…”

Application Progress of High-Throughput Sequencing in Ocular Diseases

“…However, the culture technique can only isolate specific microorganisms that meet the conditions of the Petri dish, which fails to show the overall composition of the microbial community ( Table 3 ). Moreover, culture techniques typically require several weeks or more to provide conclusive results, and the rate of positive results is low [ 15 ], requiring the aid of other pathogen detection methods.…”

“…Even if the patient has been clinically cured, the etiology remains unclear, which necessitates the identification of the causative agent of infection. The microbiological diagnosis by microbial culture technology has made outstanding contributions to infectious eye diseases, not only by culturing pathogenic microorganisms but also by evaluating their drug sensitivity [ 15 ]. It is considered the “gold standard” for diagnosing infectious ocular diseases [ 16 ].…”

Targeted metagenomics using next generation sequencing in laboratory diagnosis of culture negative endophthalmitis

“…The reported culture positivity vary widely. In a prospective multi-centric study from USA the endophthalmitis vitrectomy study group (EVS) reported 69% culture positivity ( Barza et al., 1997 ); a study from New Zealand reported 51% culture positivity ( Bhikoo et al., 2020 ). However in countries where antibiotic use is very common and indiscriminate, most patients had already received antibiotics prior to hospital visit which may result in low culture positivity.…”