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Duncan A. Friedman, Mark L. Hill, Sejal Amin, Andrew Bartlett, Richard M. Feist, John O. Mason, III, Martin L. Thomley, Michael A. Albert, Jr., Jacob J. Yunker, Tracy L. Emond; Bacterial Susceptibility Profiles in Trauma Associated Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1675.
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Previous studies have pointed out the need for broad antibiotic coverage in endophthalmitis associated with recent ocular trauma. No specific guidelines exist as to which antibiotics would serve as adequate coverage for the most common bacteria seen in traumatic endophthalmitis.
A retrospective chart review of all cases of endophthalmitis associated with trauma was performed for all patients presenting to a Level 1 Eye Trauma hospital between 2006 and 2010. Data included patient demographics, nature of injury, source of culture, and susceptibility profiles for positive bacterial cultures. Positive cultures were analyzed for specifics of mechanism of injury to characterize suspected pathogens. An antibiogram was constructed from all positive cultures.
A total of 33 cases of trauma associated endophthalmitis occurred over the four year period observed. Fifty-six percent of all trauma associated endophthalmitis cultures grew specific bacteria. Of the positive cultures, 39% grew multiple microbes. Ninety-three percent of these organisms were gram-positive bacteria. All Gram positive organisms were susceptible to vancomycin while all Gram negative organisms were susceptible to 3rd generation cephalosporins.
Endophthalmitis associated with recent trauma can be caused by both Gram positive and Gram negative organisms. Many times, these injuries result in multiple bacteria contributing to the overall inflammatory milieu. Susceptibility testing reveals that most organisms are susceptible to vancomycin with no resistant strains found. Adequate broad spectrum coverage can be achieved with the use of intraocular vancomycin and ceftazidime.
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