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Andrew M. Schimel, Darlene Miller, Harry W. Flynn, Jr.; Vitreous Isolates and Antibiotic Sensitivities: An 8-year Review of Culture-proven Endophthalmitis Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5598.
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To investigate the spectrum of organisms causing culture-proven endophthalmitis and their sensitivities to commonly used antimicrobial agents.
Medical records were reviewed of all patients with culture-proven endophthalmitis at a single institution between 9/31/02 and 6/30/10. The outcome measures included intravitreal isolates identified as well as antibiotic sensitivities.
In all, 369 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 32.8% (121/369), Streptococcus viridians group in 7.9% (29/369), Staphylococcus aureus in 7.6% (28/369), Candida albicans in 6.2% (23/369), other coagulase-negative staphylococci in 6.0% (22/369), Propionibacterium acnes in 5.4% (20/369), and Pseudomonas aeruginosa in 3.25% (12/369). Overall, 269 of 369 (72.9%) isolates were gram-positive organisms, 40 (10.8%) were gram-negative organisms, 58 (15.72%) were fungi, and 2 (0.5%) were viruses. For gram-positive organisms, sensitivities were the following: vancomycin 100%, gentamicin 83.4%, sulfamethoxazole/trimethoprim 76.2%, levofloxacin 57.5%, oxacillin 54.5%, gatifloxacin 50%, ciprofloxacin 49.7%, and moxifloxacin 46.4%. For gram-negative organisms, sensitivities were the following: ceftazidime 100%, levofloxacin 100%, gentamicin 95.5%, ciprofloxacin 94.3%, tobramycin 89.3%, and sulfametoxazole/trimethoprim 55.6%.
In considering antibiotic treatment of endophthalmitis, it is critical to recognize that no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy is generally the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may justify the use of initial antifungal agents.
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