Abstract
Purpose :
To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive (MSSE) and methicillin-resistant (MRSE) Staphylococcus epidermidis.
Methods :
Clinical and microbiology records were reviewed for 83 eyes of 83 patients who presented to a tertiary referral center between 2006 and 2015 with endophthalmitis caused by Staphylococcus epidermidis. The cohort was then compared to cases from the prior decade.1
Results :
The most common clinical settings were following cataract surgery in 43/83 (52%) eyes, intravitreal injection (18/83, 22%, eyes), trauma (6/83, 7%, eyes), glaucoma surgery (5/83, 6%, eyes), and penetrating keratoplasty (5/83, 6%, eyes). The initial treatment included intravitreal vancomycin and ceftazidime in 76/83 (92%) eyes and intravitreal vancomycin and amikacin in 7/83 (8%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 73/83 (88%) and pars plana vitrectomy in 10/83 (12%) eyes. All isolates were sensitive to vancomycin in both decades. In the most recent decade, visual acuity at last follow-up was ≥5/200 in 60/83 (72%) eyes. Isolates were sensitive to methicillin in 38/83 (46%) eyes and resistant in 45/83 (54%) eyes. Moxifloxacin sensitivity was 32% overall including 53% of MSSE and 15% of MRSE. In the prior decade, visual acuity at last follow-up was ≥5/200 in 71/86 (83%) eyes. Isolates were sensitive to methicillin in 34/86 (40%) eyes and resistant in 52/86 (60%) eyes. Moxifloxacin sensitivity was 68% overall including 73% of MSSE and 67% of MRSE.
Conclusions :
In both decades, all Staphylococcus epidermidis isolates were sensitive to vancomycin. However, sensitivity to fluoroquinolones has dropped from 68% in the prior decade1 to 32% in the most recent decade. Visual acuity outcomes and methicillin sensitivity rates were similar between decades.
[1] Miller DM, Vedula AS, Flynn HW Jr et al. Endophthalmitis caused by Staphylococcus epidermidis: in vitro antibiotic susceptibilities and clinical outcomes. Ophthalmic Surg Lasers Imaging. 2007 Nov-Dec;38(6):446-51.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.