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C. R. Alabiad, D. Miller, G. A. Lalwani, H. W. Flynn; Endophthalmitis After Clear Corneal Cataract Surgery: Fluoroquinolone Resistant Isolates. Invest. Ophthalmol. Vis. Sci. 2007;48(13):680.
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To investigate the visual acuity outcomes and antibiotic sensitivity profiles in cases of endophthalmitis resulting from fluoroquinolone resistant organisms (FROs).
The clinical and microbiological records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at the Bascom Palmer Eye Institute between January 1996 and December 2005. Antimicrobial sensitivities of organisms cultured from patients with endophthalmitis were established via the e-test and the disk diffusion technique. In-vitro fluoroquniolone resistant isolates were identified. FROs were defined as a resistance to either ciprofloxacin, levofloxacin, moxifloxacin, or gatifloxacin. A favorable visual acuity outcome was defined as a final visual acuity (VA) of 20/40 or better.
In the current study, 73 patients with culture positive endophthalmitis after cataract surgery were identified over the ten year period. 24/73 isolates (32.9%) were associated with FROs. This subgroup of patients was comprised of 9 women and 15 men (mean age+SD; 81+7.6 years) with a visual acuity of 20/50 or worse at the time of diagnosis. All cases associated with FROs were diagnosed by community ophthalmologists and referred to our institution for treatment. The average time (days+SD) between cataract surgery and the clinical diagnosis of endophthalmitis was 14+12 days. In the FRO group, Staphylococcus epidermidis was isolated in 22/24 (91.7%) while Staphylococcus aureus was isolated in 2/24 (8.3%). Fluoroquinolone resistant Staphylococcal isolates were also resistant to methicillin in 22/24 (91.7%), gentamicin in 11/24 (46%), sulfamethoxazole in 8/24 (33%), and erythromycin in 18/23 (79%) tested isolates. All isolates were sensitive to vancomycin. A favorable visual acuity outcome (VA≥20/40) was achieved in 12/24 (50%) of the FRO group compared to 24/49 (49%) of the non-FRO group.
Fluoroquinolone resistance occured in 32.9% of endophthalmitis isolates after cataract surgery. All isolates were sensitive to vancomycin. Visual outcomes among patients with endophthalmitis from FROs and non-FROs were similar.
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