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Andrew M. Schimel, Darlene Miller, Harry W. Flynn, Jr.; Vitreous Isolates and Antibiotic Sensitivities: A 10-year Review of Culture-proven Endophthalmitis Cases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1681.
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To investigate the spectrum of organisms causing culture-proven endophthalmitis and their sensitivities to commonly used antimicrobial agents.
Medical records were reviewed of all patients with culture-proven endophthalmitis at a single institution from 2002 through 2011. The outcome measures included intravitreal isolates identified as well as antibiotic sensitivities.
In all, 443 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 30.0% (133/443), Streptococcus viridians group in 11.1% (49/443), Staphylococcus aureus in 7.9% (35/443), Candida albicans in 5.6% (25/443), other coagulase-negative staphylococci in 5.8% (26/443), Propionibacterium acnes in 4.7% (21/443), and Pseudomonas aeruginosa in 3.2% (14/443). Overall, 323 of 443 (72.9%) isolates were gram-positive organisms, 48 (10.8%) were gram-negative organisms, 70 (15.8%) were fungi, and 2 (0.5%) were viruses. For gram-positive organisms, sensitivities were the following: vancomycin 100%, gentamicin 87.8%, sulfamethoxazole/trimethoprim 77.2%, levofloxacin 58.8%, oxacillin 54.5%, ciprofloxacin 51.2%, gatifloxacin 50.9%, and moxifloxacin 47.3%. For gram-negative organisms, sensitivities were the following: ceftazidime 100%, levofloxacin 100%, ciprofloxacin 95.0%, tobramycin 90.6%, gentamicin 80.6%, and sulfametoxazole/trimethoprim 59.4%.
In the current study, no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy is generally the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may guide the use of initial antifungal agents.
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