Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study

Abstract

Purpose To identify the microbial aetiology of infectious endophthalmitis and to determine the in vitro antibacterial susceptibilities of bacterial isolates. Methods A retrospective analysis was carried out of all patients presenting between January 1997 and December 2006 with clinically diagnosed infectious endophthalmitis who underwent microbiological evaluation. Intraocular specimens (aqueous and vitreous fluids) were collected from all cases of clinically suspected infectious endophthalmitis. In addition to intraocular aspirates, blood specimens from endogenous endophthalmitis, and corneal and scleral scrapes from relevant cases were also collected. The collected intraocular specimens, blood specimens, and corneal and scleral scrapes were subjected to microbiological evaluation. Results Samples from 955 patients with endophthalmitis underwent microbiological analysis, of which 424 (44.4%) were found to be culture positive. Of 424, 364 (85.8%) had bacterial growth and the remaining 60 (14.2%) had fungal growth. Among post-surgical endophthalmitis, Gram-negative bacilli (75%) were found to be the predominant cause for developing fulminant onset, Staphylococcus spp. (68.6%) for acute, and Streptococcus spp. (75%) for chronic onset of infections, whereas in post-traumatic endophthalmitis, Gramnegative bacilli (65.2%) were found to be the predominant cause for fulminant onset, Gram-positive bacillus (28.4%) for acute onset, and fungi (52.3%) for chronic onset of infections. Endophthalmitis associated with microbial keratitis was mainly caused by filamentous fungi (37.2%) and Gram-negative bacilli (37.2%). Overall, gatifloxacin (97.7%) showed highest activity against bacterial isolates followed by ciprofloxacin (95.9%) and ofloxacin (95.1%). Conclusion Gram-negative bacilli cause predominantly fulminant onset, Staphylococci and Gram-positive bacilli acute, and Streptococci, Nocardia, and fungi chronic endophthalmitis. Gatifloxacin demonstrated greatest efficacy against these bacterial isolates.

Eye preservation tectonic graft using glycerol-preserved donor cornea

“…Moreover, Pseudomonas keratitis/ scleritis infections account for 44.4% of endophthalmitis cases at our institute. [23][24][25][26][27] Our patients had very good postoperative courses (Table 1). With a mean follow-up time of 25.35 months (range, 7-56 months), infections were eradicated without recurrence in all eyes, satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization; six grafts (48.85%) with delayed reepithelialization and graft melting were repaired with conjunctival flaps to maintain ocular surface integrity.…”

Fungal, Mycobacterial, and Nocardia infections and the eye: an update

“…9,51 A large number of these cases are reported from South India. 9,51,52 Similar to keratitis and scleritis, the organism produces a slow insidious disease; the mean time to presentation from symptom onset was 21.5 ± 20.6 days and the mean duration from surgery to presentation was 47.5 ± 49.4 days in our series. 9 The clinical picture is characterized by distinctive anterior chamber findings such as the exudates on corneal endothelium or nodule-like deposits at the pupillary border in significant number of patients.…”

“…These intense anterior segment findings are coupled with minimal vitritis or posterior segment findings. 9,51,52 Cases with advanced endophthalmitis present with white fluffy exudates on posterior capsule and anterior vitreous mimicking fungal endophthalmitis. The clinical presentation in endogenous endophthalmitis is much different than exogenous endophthalmitis and is characterized by large choroidal lesions with overlying haemorrhages.…”

Endophthalmitis following open-globe injuries

“…32 Culture positivity from a vitrectomy specimen or IOFB does not always equate to clinical infection and clinical course should be monitored carefully in this setting.…”