June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical etiologies, microbial spectrum, antibiotic susceptibilities, and visual acuity outcomes of acute endophthalmitis
Author Affiliations & Notes
  • Louise Lu
    Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, United States
  • Ron A Adelman
    Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, United States
  • Footnotes
    Commercial Relationships   Louise Lu, None; Ron Adelman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5519. doi:
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      Louise Lu, Ron A Adelman; Clinical etiologies, microbial spectrum, antibiotic susceptibilities, and visual acuity outcomes of acute endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5519.

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

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Abstract

Purpose : The purpose of this study is to report the clinical etiologies, microbial spectrum, antibiotic resistance, and visual acuity outcomes associated with acute endophthalmitis at a tertiary referral center.

Methods : A retrospective chart review of patients with ICD-9 and ICD-10 codes for endophthalmitis over a six year period (2011-2016) at a tertiary referral center was performed. The clinical records were reviewed to evaluate clinical etiologies, microbial spectrum, antibiotic susceptibilities and resistance, and visual outcomes.

Results : Medical records of 94 patients treated for culture-proven endophthalmitis were reviewed. The etiologies of endophthalmitis were exogenous in 68.8% of cases and endogenous in 31.2% of cases. The most common inciting factors for exogenous endopthalmitis were progression of corneal ulcer and post-operative infection after cataract extraction (22% and 17%, respectively). The microbial spectrum of causative organisms was dominated by coagulase-negative Staphylococcus (30.9%), followed by Staphylococcus aureus (23.4%) and Pseudomonas aeruginosa (10.6%). The most frequent fungal isolates were Candida species (4.3% of total samples). Antibiotic susceptibilities of Gram-positive bacteria were the following: vancomycin, 96.7%; cefazolin, 79.3%, clindamycin, 69.0%, doxycycline, 96.6%, erythromycin 55.9%, gentamicin, 96.6%, oxacillin 69.0%, penicillin G, 28.8%, and TMP+SMX 84.4%. Antibiotic susceptibilities of Gram-negative bacteria were overall very high, with greater than 90% susceptibility among isolated culture samples. Final visual acuity (VA) outcomes of 20/400 or better were reported in 62.5% of patients; counting fingers, hand motion, or light perception were reported in 10.0% of patients; and no light perception (NLP) was reported in 27.5% of patients for whom VA data was available.

Conclusions : The study demonstrates that the most frequent clinical etiology of endophthalmitis was due to progression of corneal ulcer and post-operative infection after cataract extraction. The spectrum of pathogens causing endophthalmitis is composed of mainly Gram-positive organisms, with a smaller fraction composed of Gram-negative organisms and some fungi. Visual acuity was improved in the majority of patients after treatment for endophthalmitis; nevertheless, a significant percentage of patients had a final visual acuity of no light perception (NLP).

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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