Abstract
Purpose: :
To investigate the clinical settings, management strategies, antibiotic sensitivities, and visual outcomes for eyes with endophthalmitis caused by Staphylococcus epidermidis.
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: endophthalmitis • microbial pathogenesis: clinical studies • retina