Ocular streptococcal infections: A clinical and microbiological review

Nanayakkara, Upeka; Khan, Muhammad Azaan; Hargun, Dilnoor Kaur; Sivagnanam, Shobini; Samarawickrama, Chameen

doi:10.1016/j.survophthal.2023.02.001

Cited by 4 publications

(2 citation statements)

References 129 publications

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“…Previous studies have reported that VGS or S. pneumoniae is the most common pathogen of streptococcal endophthalmitis, varying in different regions, climates, and endophthalmitis etiologies [ 20 , 25 ]. VGS is commonly found in the oropharynx, respiratory tract, female genital tract, and gastrointestinal tract and is rarely found in normal conjunctival flora [ 21 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features, Antibiotic Susceptibilities, and Outcomes of Endophthalmitis Caused by Streptococcal Infection: Children vs. Adults

Yang

Wong

et al. 2023

Antibiotics

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Streptococcus spp. are common causative organisms of endophthalmitis. Analysis of the clinical features, antibiotic susceptibilities, and outcomes of streptococcal endophthalmitis in children and adults may guide future management. Sixty-seven patients (67 eyes) with streptococcal endophthalmitis who were admitted to the Zhongshan Ophthalmic Center between January 2013 and December 2022 were retrospectively reviewed. The mean age was 20.7 ± 21.6 years, and 59.7% were children. Streptococcal infection accounted for 13.9% of culture-proven bacterial endophthalmitis cases; the proportion was higher in children than in adults (32.3% vs. 7.6%, p < 0.01) and increased from 8.1% in 2013–2017 to 20.1% in 2018–2022 (p < 0.01). Eye trauma was the most common etiology in both children and adults (82.5% and 66.7%, respectively). Viridans group streptococci were the most common isolates, followed by S. pneumoniae. The susceptibility rates of the streptococci to vancomycin, cefuroxime, and levofloxacin were 100%, 95.5%, and 93.0%, respectively. The overall mean best-corrected visual acuity increased from 2.74 ± 0.19 logMAR initially to 2.32 ± 0.75 logMAR at the last follow-up (p < 0.05). In conclusion, streptococcal infections have increased in cases of bacterial endophthalmitis in recent years and are more common in children. The commonly used antibiotics, vancomycin, cefuroxime, and fluoroquinolone, showed higher antibiotic susceptibility. After prompt treatment, visual outcomes improved.

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Section: Discussionmentioning

confidence: 99%

Clinical Features, Antibiotic Susceptibilities, and Outcomes of Endophthalmitis Caused by Streptococcal Infection: Children vs. Adults

Yang

Wong

et al. 2023

Antibiotics

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“…In the context of endophthalmitis, various studies have reported that patients with gram-positive samples including Enterococci were strongly susceptible to vancomycin, while gram-negative isolates showed full to intermediate susceptibility to ceftazidime, highlighting intravitreal use of these broad-spectrum medications as a first-line treatment [ 65 , 66 , 67 ]. Some reports have shown concerning cases with vancomycin resistance [ 9 , 68 , 69 , 70 ]. Among patients with gram-positive cultures resistant to vancomycin, linezolid or daptomycin have been used as alternative treatments [ 71 , 72 ].…”

Section: Antimicrobial Resistance Associated With Endophthalmitismentioning

confidence: 99%

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis

Garcia O’Farrill,

Abi Karam,

Villegas

et al. 2024

Pharmaceuticals

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Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.

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