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C. P. Nix, D. M. Miller, D. Miller, H. W. Flynn, Jr.; Endophthalmitis Caused by Staphylococcus epidermidis: A Ten Year Review of Antibiotic Sensitivities and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):956.
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To investigate the clinical settings, management strategies, antibiotic sensitivities, and visual outcomes for eyes with endophthalmitis caused by Staphylococcus epidermidis.
A retrospective, consecutive case series of all patients treated for culture-proven S. epidermidis endophthalmitis at the Bascom Palmer Eye Institute between January 1, 1996 and December 31, 2006 was conducted.
The study included 119 eyes from 119 patients. Clinical settings included post-cataract (73), glaucoma (17), trauma (14), penetrating keratoplasty (6), vitrectomy (4), intravitreal injection (3), corneal suture ulcer (1), and endogenous (1). A vitreous tap and inject was performed initially in 91 (76%) eyes and a vitrectomy was performed initially in the remaining 28 (24%) eyes. All eyes received intravitreal vancomycin and either ceftazidime or amikacin on the day of presentation. In vitro antibiotic sensitivities of the isolates were as follows: vancomycin,100% (119/119); gatifloxicin, 64% (42/66); moxifloxicin, 62% (39/63); and, methacillin/oxicillin, 60% (71/119). More recent isolates were also tested for sensitivity to the newer antibiotics linezolid and quinupristin/datfopristin. Of the 34 isolates tested, 100% were sensitive to both linezolid and quinupristin/datfopristin. Best visual acuity after treatment was 20/40 or better in 43 (36%) eyes; 20/50 to 20/200 in 35 (30%) eyes; 20/400 to 5/200 in 17 (14%) eyes; and, <5/200 in 24 (20%) eyes.
Although all S. epidermidis isolates remained sensitive to vancomycin, a large number were resistant to the fourth generation fluoroquinolones. All tested isolates resistant to these fourth generation fluoroquinolones were sensitive to the newer antibiotics, linezolid and quinupristin/datfopristin. Endophthalmitis caused by S. epidermidis may present in a number of clinical settings and may lead to both favorable and unfavorable visual outcomes.
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