Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes

Abstract

Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Clinical Characteristics, Antimicrobial Resistance, and Outcomes of Patients with Invasive Pneumococcal Disease in Ningxia Hui Autonomous Region, China, 2013–2021

“…The nonsusceptibility rates of penicillin in bacteremia and meningitis isolates (1.3% and 65.9%) were lower than in a study conducted in Beijing China (8.5% and 71.9%) [ 16 ]. Consistent with many studies [ 47 – 49 ], S. pneumoniae in the present study is generally sensitive to vancomycin, linezolid, and levofloxacin, with 100% susceptibility. Erythromycin, clarithromycin, and azithromycin are the three most widely used macrolide antibiotics in the clinic.…”

The application value of metagenomic next-generation sequencing in children with invasive pneumococcal disease

“…Moreover, it has been reported that the total carrying rate of S. pneumoniae in children is up to 17.8% (14). Patients with IPD are at risk of insomnia, hearing impairment, language and mental developmental delays (15)(16)(17), and even septic shock and death in severe cases (18). For children, delayed treatment of IPD can increase the risk of septic shock and mechanical ventilation by 4.58 times and 2.7 times, respectively, and the risk of death by nearly 40 times (19).…”

Ocular Bacterial Infections: A Ten-Year Survey and Review of Causative Organisms Based on the Oklahoma Experience

“…S. pneumoniae are the most commonly isolated streptococci from ocular infections such as conjunctivitis, endogenous and exogenous endophthalmitis, and keratitis [ 156 , 157 ]. S. pneumoniae is also the most common cause of bacterial keratitis in low-income countries [ 158 ].…”

“…Among keratitis isolates, S. pneumoniae has been reported to have been isolated in 2% to 46.80% of cases ( Table 4 ). In cases of endophthalmitis, even with prompt treatment, there is a high risk of profound vision loss and enucleation or evisceration in eyes infected with S. pneumoniae [ 156 , 157 ]. Chen et al [ 157 ] reported that of 38 cases of S. pneumoniae endophthalmitis, 84% resulted in light perception to no light perception, and 26% underwent evisceration or enucleation.…”

“…S. pneumoniae possesses a number of virulence factors, such as a polysaccharide capsule, neuraminidase, pneumolysin, and zinc metalloproteinases [ 157 ]. The polysaccharide capsule enables S. pneumoniae to evade phagocytosis by inhibiting complement-mediated opsonization and is found in the majority of invasive isolates [ 159 ].…”