June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical presentation, microbiologic profile and factors predicting outcomes in Bacillus endophthalmitis
Author Affiliations & Notes
  • Vivek Dave
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Avinash Pathengay
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Savitri Sharma
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Rajeev Pappuru
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Raja Narayanan
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Taraprasad Das
    LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Footnotes
    Commercial Relationships   Vivek Dave, None; Avinash Pathengay, None; Savitri Sharma, None; Rajeev Pappuru, None; Raja Narayanan, None; Taraprasad Das, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5506. doi:
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      Vivek Dave, Avinash Pathengay, Savitri Sharma, Rajeev Pappuru, Raja Narayanan, Taraprasad Das; Clinical presentation, microbiologic profile and factors predicting outcomes in Bacillus endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5506.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Bacillus species include one of the commonest etiologies in endophthalmitis. Though trauma is the commonest presenting clinical scenario, the risk factors predicting treatment outcomes are unknown. In this retrospective observational case study, we describe the clinical presentation, microbiologic profile and factors predicting outcomes.

Methods : Eighty-six cases with culture proven Bacillus endophthalmitis from January 2001 to December 2015 received vitrectomy/ vitreous biopsy and intravitreal antibiotic with or without steroid as appropriate. The undiluted vitreous biopsy underwent microbiologic evaluation. The duration of symptoms, presenting visual acuity, organisms isolated, influence of intravitreal dexamethasone with intravitreal antibiotics and type of initial intervention were examined for any clinical and statistical correlation in terms of odds ratio with the final visual outcome. Favorable visual outcome was defined as vision >20/400 and unfavorable visual outcome when vision was < 20/400.

Results : The mean age at presentation was 25.45±19.76 years with a median of 22.5 years and range of 0.5-82 yrs. Trauma was the commonest etiology (n=75; 87.2%) . Mixed infection with other bacteria was seen in 11 cases (12.79%). The mean time between onset of complaints and presentation was 4.54±8.18 days, median 1, range 0 to 45 days. All Bacillus species were sensitive to gentamicin followed by vancomycin (n=81; 94.18%) and ciprofloxacin (n=85; 98.83%). The mean follow up was 7.45±12.17 months (median 3, range 0.5-72 months). The odds ratio(OR) indicated a favorable outcome when presenting vision was greater than hand motions (OR 31, 95% C.I. 2.96-323.64 ,p=0.004), when treatment started within 48 hours of symptoms (OR 25, 95% C.I. 2.45-254.16, p=0.006), culture was non-polymicrobial (OR 18.03, 95% C.I. 0.9-344.4 , p=0.054). Use of intravitreal dexamethasone and initial vitrectomy instead of a limityed vitreous biopsy showed a trend towards more favorable outcome. Only 20% of all treated patients regained ambulatory vision and one fifth of all cases developed phthisis.

Conclusions : Cases diagnosed with Bacillus endophthalmitis merit aggressive vitreous intervention guided by the culture sensitivity report. Despite early and appropriate treatment, the outcomes are generally poor.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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