Nosocomial Acute-Onset Post Operative Endophthalmitis Survey: An 11-Year Review of Incidence, Causative Organisms and Outcomes

Abstract

Purpose:: To evaluate the incidences, causative organisms, and surgical procedures associated with acute-onset (within 6 weeks after surgery) postoperative endophthalmitis at a university teaching hospital over an 11-year period.

Methods:: This retrospective, observational case study, reviewed all of the surgical cases performed between January 1, 1995 and December 31, 2005 at that Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, University of Miami Medical Center for the occurrence of nosocomial acute-onset postoperative endophthalmitis.

Results:: During the 11-years examined, 29 cases of acute-onset postoperative endophthalmitis after intraocular surgery were reported. The distribution of acute-onset postoperative endophthalmitis by surgical category were as follows: cataract surgery with or without intraocular lens 14 (48.3%); pars plana vitrectomy 4 (13.8%); penetrating keratoplasty 4 (13.8%); secondary IOL placement 1 (3.4%); glaucoma filtration procedures 5 (17.2%); and combined trabeculectomy and cataract surgery 1 (3.4%). These cases represent a cumulative incidence over the period studied of 0.0395% (14/35420) for cataract surgery and 0.0247% (4/16168) for pars plana vitrectomy. A range of gram positive, gram negative, and atypical organisms were isolated from anterior and posterior chamber paracenteses. The two most frequent isolates were Staphylococcus epidermidis (34.5%, 10/29) and Pseudomonas aeruginosa (10.3%, 3/29). The incidence of postoperative endophthalmitis in this study was 0.0395% for cataract surgery and 0.0247% for pars plana vitrectomy which represents a decrease in incidence at the same institution as compared to the reported incidence from 1984-1994 (rates of 0.082% and 0.046% respectively) (Aaberg et al. Ophthal 105:1004). While the overall rates of institutional postoperative endophthalmitis decreased, the predominant organism isolated in postoperative endophthalmitis remained Staphylococcus epidermidis.

Conclusions:: The rates of acute-onset postoperative endophthalmitis remain low and continue to decrease in the setting of the single university-affiliated hospital studied. Although overall rates decreased, the single most common isolate remained Staphylococcus epidermidis.

Keywords: endophthalmitis • clinical (human) or epidemiologic studies: outcomes/complications