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Kathleen Weiss, Ajay Kuriyan, Harry Flynn, Darlene Miller; Endophthalmitis Caused by Streptococcal Species. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1109.
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To describe the clinical features, antibiotic sensitivities, and outcomes of endophthalmitis caused by Streptococcus species.
Retrospective case series of 38 patients with culture-proven endophthalmitis caused by Streptococcus species from 1/1/00 to 7/8/11.
The most common Streptococcal species in our study was S. viridans (76.9%), followed by S. pneumoniae (15.4%), miscellaneous Streptococcus species (5.1%), and Group B Streptococcus (GBS, 2.6%). The clinical settings included acute post-cataract (31.6%), post-intravitreal (IV) injection (28.9%), bleb-related (21.1%), trauma (7.9%), penetrating keratoplasty-related (7.9%), and endogenous infections (2.6%). The most common presenting visual acuity (VA) was light perception (LP, 56.8%), followed by hand motion (HM, 29.7%) and ≥4/200 (13.5%). Initial treatment included IV antibiotics (76.3%), pars plana vitrectomy (PPV) with IV antibiotics (21.1%), and evisceration (2.6%). In patients initially treated with IV antibiotics, 34.5% required subsequent PPV. Overall, 100% of the streptococcal isolates were sensitive to vancomycin and levofloxacin, while 89.5% were sensitive to ceftazidime. Lower rates of sensitivity to ceftazidime were found in the S. pneumoniae (75%) and S. viridans (92.3%) than GBS (0%) and miscellaneous (0%) isolates. At 1-month follow-up, enucleation or evisceration was performed in 20.6% of patients; of the remaining patients, the VA outcomes were the following: ≥20/400 (37%), 1 to 4/200 (14.8%), HM to LP (33.3%), and no light perception (NLP, 14.8%).
In the current study of endophthalmitis caused by Streptococcus, the most common isolate was S.viridans and the most common clinical setting was post-cataract surgery. All isolates were sensitive to vancomycin and levofloxacin and the majority of isolates were sensitive to ceftazidime. Endophthalmitis caused by Streptococcus generally resulted in poor VA outcomes.
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