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A. R. Shirodkar, C. Alabiad, G. Lalwani, D. Miller, H. W. Flynn, Jr.; Acute-Onset Endophthalmitis After Cataract Surgery: Outcomes in Isolates Resistant to versus Sensitive to Fluoroquinolones. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3561.
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To identify patients who developed acute-onset endophthalmitis after cataract surgery caused by fluoroquinolone-resistant organisms, and compare treatment outcomes to cases caused by fluoroquinolone-sensitive organisms.
Retrospective chart review of patients who developed endophthalmitis within six weeks of cataract surgery, and were treated between the years of January 1996 and September 2008. Clinical parameters evaluated included time to diagnosis, visual acuity at diagnosis, cultured organism, presence of hypopyon, and visual acuity at final followup.
A total of 128 patients met study criteria, and 35 (27%) demonstrated fluoroquinolone resistance in culture. All fluoroquinolone-resistant endophthalmitis in the study was caused by either Staphylococcus epidermidis (86%) or Staphylococcus aureus (14%). Presenting visual acuity was < 5/200 in 94% of fluoroquinolone-resistant cases, and 85% of fluoroquinolone-sensitive cases. Hypopyon was inititally present in 86% and 85% of fluoroquinolone-resistant and fluoroquinolone-sensitive cases, respectively. Average time to diagnosis was 11 days for the fluoroquinolone-resistant group, and 12 days for the fluoroquinolone-sensitive group. Final visual acuity was ≥20/40 in 46% of fluoroquinolone-resistant cases and 47% of fluoroquinolone-sensitive cases; the results are comparable in both groups, and also similar to that seen in the EVS (53%). All fluoroquinolone-resistant isolates were sensitive to vancomycin.
In the current study, approximately one fourth of isolates were resistant to fluoroquinolones. There was no significant difference in clinical outcomes in this study, regardless of fluoroquinolone sensitivity.
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