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T. Leng, D. Miller, H. W. Flynn, Jr.; Endophthalmitis Caused by Proteus Species: Antibiotic Sensitivities and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):961.
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To report the clinical presentations, causative organisms, antibiotic sensitivities, management strategies, and visual acuity outcomes in patients with endophthalmitis caused by Proteus species.
Retrospective consecutive case series. The Bascom Palmer Eye Institute Microbiology Laboratory database was reviewed to identify all patients with intraocular cultures positive for Proteus species between 1983 and 2007. Clinical records and microbiological testing were reviewed using a data collection form.
Thirteen patients were identified. Presumed etiologies for endophthalmitis included the following: cataract surgery (9), combined cataract surgery and trabeculectomy with the application of mitomycin C (1), combined glaucoma drainage device implantation with vitrectomy (1), combined vitrectomy and scleral buckle revision (1), and recurrent corneal ulcer after penetrating keratoplasty (1). Endophthalmitis developed 2-14 days postoperatively (median, 3.5 days) and patients were followed 1-61 months after presentation (median, 17 months). Presenting vision ranged from light perception to 20/200. Culture results were the following: Proteus mirabilis (10) and Proteus morganii (3). Polymicrobial infections occurred in 4 patients (31%). Tested bacterial isolates were sensitive to the following antibiotics: aminoglycosides (13 of 13), ceftazidime (2 of 2), and ciprofloxacin (8 of 8). All isolates were sensitive to the antibiotics clinically administered. Initial treatment strategies included: injection of intravitreal antibiotics alone (6) and vitrectomy with injection of intravitreal antibiotics (7). Two of the patients who received vitrectomies had either an IOL or retained nuclear fragments removed. One patient received additional antibiotic injections during the clinical course and 5 patients underwent additional surgical procedures in addition to receiving antibiotic injections. Final visual acuity was ≥ 20/400 in 3 patients (23%) and 7 eyes had a final visual acuity of no light perception (54%).
Despite prompt treatment with appropriate antibiotics, the clinical outcome for endophthalmitis caused by Proteus species is generally poor.
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