Abstract
Purpose::
To investigate the clinical settings, management strategies, antibiotic sensitivities, and visual outcomes of endophthalmitis caused by Enterococcus faecalis.
Methods::
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.
Results::
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%).
Conclusions::
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.
Keywords: endophthalmitis • antibiotics/antifungals/antiparasitics