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J.J. Miller, H.W. Flynn, Jr., W.E. Smiddy, T.G. Murray, I.U. Scott, D. Miller; Endophthalmitis Caused by Bacillus . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5279.
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To investigate the clinical settings, management strategies, and visual outcomes for patients with endophthalmitis caused by Bacillus species and to review the in vitro effectiveness of commonly used antibiotics against this organism.
Records were reviewed of all patients with culture–positive endophthalmitis caused by Bacillus species treated at the Bascom Palmer Eye Institute between January 1990 and February 2005.
Nineteen eyes of 19 patients met study inclusion criteria. There were 18 males and one female, and the median age was 31 years (range: 6 to 93 years). The median follow up was 20 months (range: 4 to 122 months). Clinical settings included open globe injury (16 eyes), endogenous (2 eyes), and delayed–onset, bleb–associated (1 eye). Twelve (75%) of 16 patients with open globe injuries had concomitant intraocular foreign bodies. Initial visual acuity was hand motions or better in 12 (63%) of 19. Initial therapeutic procedures included pars plana vitrectomy and injection of antibiotics in 13 (68%) eyes, vitreous tap and injection of intravitreal antibiotics in 5 (26%) eyes, and primary evisceration in 1 (5%) eye. Four patients (21%) received additional doses of intravitreal antibiotics, while 15 (79%) underwent secondary surgical procedures. All patients received intraocular vancomycin as well as a cephalosporin or an aminoglycoside. Systemic antibiotics were used in the majority of patients, including a cephalosporin in 63% and fluoroquinolones in 21%. Fourteen (74%) of 19 isolates were Bacillus cereus, while the remaining isolates were Bacillus species other than B. cereus. In vitro antibiotic sensitivities were conducted on the stored isolates. All isolates were sensitive to vancomycin, gentamicin, and the fluoroquinolones. Only 8% of isolates were sensitive to cephalosporins.
Endophthalmitis caused by Bacillus species often results in poor visual outcomes. The in vitro antibiotic sensitivities of endophthalmitis isolates supports the use of oral fluoroquinolones as Bacillus species prophylaxis in patients with open globe injuries.
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