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Patrick Staropoli, Harry W Flynn, Darlene Miller, Patrice Jan Persad, Elizabeth Vanner; Endophthalmitis Caused by Streptococcal Species: Clinical Outcomes and Antimicrobial Susceptibilities 2014-2019. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1358.
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Antibiotic resistance, prevalence, surgical management, and the role of virulence factors are topics frequently debated in the literature about streptococcal endophthalmitis. We performed a retrospective consecutive case series to report the clinical settings, antibiotic susceptibilities, and outcomes of this condition.
Chart review of culture-positive streptococcal endophthalmitis from January 1, 2014 to December 31, 2019. Thirty-eight eyes met study criteria. Mann-Whitney U, Fisher’s exact test, and the exact chi-square test were used for statistical analysis.
The most common clinical setting was post-glaucoma surgery (33.3%, 12/36). The most frequent isolate was S. viridans (63.2%, 24/38). Isolates were susceptible to vancomycin (100%, 36/36), ceftriaxone (100%, 28/28), and levofloxacin (100%, 36/36). Final BCVA was better than 20/200 in 24.1% (7/29) but 20/200 or worse in 75.9% (22/29). Enucleation was performed in 11.1% (4/36). A subset (n=11) of cases were evaluated for streptococcal-specific virulence factors: pneumolysin was present in 18.2% (2/11), autolysin in 45.5% (5/11), and hyaluronidase in 54.5% (6/11). Clinical settings, antibacterial susceptibilities, timing of PPV, and virulence factor presence were not associated with better visual outcome or enucleation rate (p>0.05).
Visual prognosis for streptococcal endophthalmitis is poor despite early and appropriate antibiotic treatment.
This is a 2021 ARVO Annual Meeting abstract.
One (8.3%, 1/12) of the post-glaucoma surgery cases was acute (< 6 weeks) bleb-related endophthalmitis. Eleven (91.7%, 11/12) of the post-glaucoma cases were after trabeculectomy and one (8.3%, 1/12) was after glaucoma drainage implant.
MIC = Minimal inhibitory concentration
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