Infectious endophthalmitis: review of 420 cases

Abstract

BackgroundTo characterize the causative pathogens and the visual outcomes among patients with endophthalmitis at a large referral center in northeastern Thailand.MethodsAll cases of infectious endophthalmitis treated between 1983 and 2007 were reviewed retrospectively. The patient data – including age, sex, history of ocular injuries, previous treatment and duration of the symptoms – were recorded. The ocular examination included affected side, anterior chamber reaction, vitreous haze, and presence of intraocular foreign bodies. Smears and cultures were prepared from anterior chamber paracentesis and/or vitreous tapping. Intraocular antibiotics were administered at the time of anterior chamber paracentesis and/or vitreous tapping. Vitrectomy and/or lensectomy were performed when indicated. Initial visual acuity before treatment and the final best-corrected vision were compared.ResultsA total of 420 cases of endophthalmitis were reviewed: 181 cases (43.1%) had ocular trauma before the infection; 135 (32.2%) developed endophthalmitis after intraocular surgery; and, 122 (29.1%) had a positive culture. Bacteria were isolated in 114 cases (93.4%) and fungi were noted in eight (6.6%). The common causative bacterium was Staphylococcus epidermidis. Combined vitrectomy and intraocular antibiotics were performed in 189 cases (45.0%), whereas 69 cases (16.4%) were treated with intraocular antibiotics alone.ConclusionMost of the reviewed cases were associated with trauma and intraocular surgery. The most frequently encountered bacterium causing infectious endophthalmitis was S. epidermidis. Most cases were treated with combined vitrectomy and intraocular antibiotics. The final visual outcomes seem to vary according to the type of endophthalmitis.

Prevalence of drug resistance and culture-positive rate among microorganisms isolated from patients with ocular infections over a 4-year period

“…Recent developments and advances in effective antibiotics and vitreous surgeries, however, have led to the final visual outcome being markedly improved 22. In our cases, as treatments vitrectomy with intraocular irrigation with antibiotics and injection procedure with intravitreal vancomycin and ceftazidime was done in all cases as in the previous study, and infections then disappeared 23.…”

Endophthalmitis: state of the art

“…In contrast to exogenous endophthalmitis, endogenous endophthalmitis is caused by inoculation of the eye by infectious pathogens spread systemically through the bloodstream and across the blood-ocular barrier. 111 Endogenous endophthalmitis is uncommon and generally accounts for 2%–16% of all reported endophthalmitis cases 92 , 93 , 112 – 114 but the prevalence has been reported to be as high as 41% in one series. 115 …”

Modeling intraocular bacterial infections

“…Final visual outcomes depend on the type of injury, the virulence of the pathogen, and the interval between symptoms and treatment (Bhagat et al, 2011; Bhoomibunchoo et al, 2013; Lieb et al, 2003; Parrish and O’Day, 1987). Bacteria are the most common cause of post-traumatic endophthalmitis, but fungi can also be isolated, Candida species being the most common isolate (Bhagat et al, 2011).…”

“…Current recommendations for initial therapy of endophthalmitis include the use of intravitreal vancomycin hydrochloride (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) (Bhagat et al, 2011; Bhoomibunchoo et al, 2013; Kuhn and Gini, 2005; Mittra and Mieler, 1999; Roth and Flynn, 1997), antibiotics which inhibit bacterial cell wall synthesis. Vancomycin provides good coverage against Gram-positive bacteria such as Staphylococcus , Streptococcus, Enterococcus , and Bacillus species, and has been shown in the rabbit model to be safe and effective with a single dose (Callegan et al, 2011; Forster, 1992; Park et al, 1999; Smith et al, 1997; Wiskur et al, 2008b; Wiskur et al, 2009).…”