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K.-J. Chen, M.-H. Sun, C.-C. Lai, T.-L. Chen, Y.-H. Kuo, A.-N. Chao, W.-C. Wu; Endophthalmitis Caused by Enterococcus faecalis in East Asians. Invest. Ophthalmol. Vis. Sci. 2007;48(13):695.
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To investigate the clinical settings, management strategies, antibiotic sensitivities, and visual outcomes of endophthalmitis caused by Enterococcus faecalis.
Medical records were reviewed of all patients with culture-proven Enterococcus faecalis endophthalmitis at Chang Gung Memorial Hospital between January 1, 1996, and December 31, 2004.
Endophthalmitis caused by Enterococcus faecalis was identified 23 eyes of 23 patients with a median age of 75 (range, 42 to 89 years) and a median follow-up of 8 months (range, 1 months to 85 months). The clinical settings of endophthalmitis included: cataract surgery (n= 19, 83%), penetrating keratoplasty (n=2, 9%), trauma(n=1, 4% ), and endogenous source (n=1, 4%). A vitreous tap and injection of antibiotics was performed initially in 9 eyes (39%), a pars plan vitrectomy was performed initially performed in 13 eyes (57%), and evisceration was initially performed in one eye (4%). In vitro testing of E. faecalis isolated revealed that 23 of 23 (100%), 23 of 23 (100%), and 15 of 15 (100%) were sensitive to ampicillin, vancomycin, and teicoplanin; 4 of 7 (57%) were resistant to high-level gentamycin(minimum inhibitory concentration > 500mg/l). Presenting visual acuity ranged from counting fingers to no light perception, and final visual acuity ranged from 20/100 to no light perception. Final visual acuity was better than 5/200 in 3 of 23 eyes (13%), 5/200 to hand motions in 5 of 23 eyes (22%), and light perception to no light perception in 15 of 23 eyes (65%).
E. faecalis is often resistant to gentamycin but is sensitive to ampicillin, vancomycin and teicoplanin in all isolates tested. Endophthalmitis caused by E. faecalis is usually associated with poor visual outcome.
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