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Austin David Igelman, Joseph Simonett, Stanford Taylor, Christina J Flaxel; Etiology and antimicrobial trends over time in infections endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6182.
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© ARVO (1962-2015); The Authors (2016-present)
To report on pathogen species and antimicrobial susceptibilities from cases of culture-proven endophthalmitis. Additionally, to investigate changes in microbial trends and visual acuity outcomes over time.
Cases of culture proven endophthalmitis were identified through retrospective chart review of the electronic medical record at a quaternary referral center. Data collection included isolated organisms, antimicrobial susceptibilities, route of infection, intravitreal antimicrobials used, extent of surgical intervention, and presenting and final visual acuities.
117 patients with culture positive endophthalmitis were identified from July 2004 through June 2017. Isolated organisms consisted of gram-positive bacteria (n=96, 82.1%), gram-negative bacteria (n=7, 6.0%), and fungus (n=14, 12.0%). The most common gram-positive organism was coagulase negative staphylococcus. A higher proportion of bacterial organisms were susceptible to amikacin as compared to ceftazidime (94.7% versus 70.6%, respectively; p <0.05). 100% of cultures that were tested with vancomycin were found to be susceptible. Amongst all of the investigated antimicrobial agents, there were no significant changes in antibiotic susceptibilities over time. There was an increasing proportion of cases occurring after an intravitreal injection when comparing etiologies from 2004 – 2011 to 2012 – 2017 (25% and 56%, respectively; p<0.05). Visual acuity outcomes were similar in the subgroup of infectious endophthalmitis occurring after an intravitreal injection (n=34) compared to other etiologies (p=0.105).
The data from this study highlight the trends in endophthalmitis. Antimicrobial resistance patterns in this cohort did not change over time and more bacteria were susceptible to vancomycin and amikacin than ceftazidime. Additionally, endophthalmitis following intravitreal injections is becoming increasingly prominent. With further analysis of antimicrobial susceptibilities and microbial and etiological trends, providers will be better equipped to select empiric therapy for patients with sight-threatening endophthalmitis and reduce the burden of disease.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Table 1: Endophthalmitis etiology compared overtime
Table 2: Antimicrobial trends compared overtime
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