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S. Shukla, R. Gentile, M. Shah, A. Davis; Microbiological Spectrum and Antibiotic Resistance in Endophthamitis: A Nineteen Year Review. Invest. Ophthalmol. Vis. Sci. 2007;48(13):694.
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To identify the prevalence of pathogens responsible for endophthalmitis and investigate possible trends of antibiotic resistance over the past nineteen years.
Records of all cases of endophthalmitis over a nineteen-year period (1987-2005) at New York Eye and Ear Infirmary were reviewed. Only culture positive cases originating from aqueous and/or vitreous specimens were included. Microbiological spectrum and antibiotic resistance were evaluated with particular attention paid to currently used empiric intra-vitreal antibiotics.
Eight hundred eighty three consecutive cases of culture positive endophthalmitis were identified. The average age was 67.7 and 56.1 percent of patients were female. The most prevalent pathogens were coagulase-negative staphylococcus (38.3%), followed by Staph aureus (12.2%), Strep viridans species (12.1%), P. acnes (6.8 %) and Strep. pneumoniae (6.6%). Gram-negative organisms accounted for 9.2% of isolates and fungi, 4.1% . Over the course of nineteen years the spectrum of most commonly isolated gram positive organisms and the proportion of cases caused by gram negative organisms remained generally consistent. All gram-positive bacteria were sensitive to vancomycin with the exception of a single isolate of Strep viridans in 2005. Of the 81 gram negative organisms tested against ceftazidime, one Serratia sp. in 2004 and two Acinetobacter sp. in 2004 and 2005 were resistant.
Coagulase negative staphylococcus remains the most frequently identified cause of endophthalmitis. Significant changes in the spectrum and proportion of causative pathogens, including fungi and gram negative organisms, have not occurred over the past nineteen years . Vancomycin and ceftazidime appear to be excellent empiric antibiotics for treating endophthalmitis.
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