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Harry W Flynn, Nicolas Alessandro Yannuzzi, Nimesh Patel, Nidhi Relhan, Kimberly D Tran, Nancy Si, Darlene Miller; Clinical outcomes and management of endophthalmitis caused by Staphylococcus epidermidis: comparison of most recent decade with the prior decade. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3877. doi: https://doi.org/.
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To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive (MSSE) and methicillin-resistant (MRSE) Staphylococcus epidermidis.
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
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.
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. 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.
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