Abstract
Purpose :
Endogenous endophthalmitis is a devastating intraocular infection resulting from hematogenous spread, and it's treatment remains challenging. The purpose of this study was to identify the microbiology of endogenous endophthalmitis, their susceptibility against current empirical antibiotics, and prognostic factors.
Methods :
Patients diagnosed with endogenous endophthalmitis at a tertiary referral center, Kaohsiung Medical University Hospital, between January 2013 to April 2023 were retrospectively reviewed. We collected and analyzed patient demographics, primary infection focus, pathogens, antibiotic susceptibility, treatment, and prognosis.
Results :
A total of 42 patients with endogenous endophthalmitis were enrolled. Pathogens were identified in 37 cases. 27 patients (64%) had underlying diabetes mellitus (DM). The most common primary infection focus was liver abscess (40.5%). Klebsiella pneumoniae was the prevailing pathogen (50%), followed by Staphylococcus aureus (19%) (8% methicillin-sensitive and 11% methicillin-resistant). All patients received topical antibiotics, 98% received systemic antibiotics, 93% received intravitreal injection and only 29% received vitrectomy. 7% patients without vitrectomy achieved final visual acuity (VA) better than hand motion (HM), whereas 17% with vitrectomy achieved final VA better than HM. The later the vitrectomy performed, the worse the final VA. The empirical IVI antibiotics were vancomycin, ceftazidime and/or dexamethasone in Taiwan. 83% patient received concomitant dexamethasone. The percentage of patients with visual loss was comparable between those treated with dexamethasone (54%) and those did not (57%). In cases of gram-negative infections, there were 67% vision loss and 33% phthisis. In gram-positive group, there were 44% vision loss and 11% phthisis.
Conclusions :
There was a high prevalence of DM, liver abscess, and Klebsiella pneumoniae in patients with endogenous endophthalmitis in Taiwan. The infections from gram-negative pathogens might be more fulminant than that from gram-positive microorganisms. Early vitrectomy potentially offered some advantages for the visual prognosis. Current empirical intravitreal injections were feasible; however certain gram-negative pathogens exhibited resistance to ceftazidime, suggesting the potential requirement for additional or alternative management.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.