Abstract
Purpose :
Compared to endophthalmitis caused by gram-positive organisms, endophthalmitis caused by gram-negative organisms is generally associated with worse visual outcomes. However, data pertaining to this uncommon condition remain limited, and there are considerable geographic variabilities in the epidemiology, microbiology, and antibiotic sensitivity profile of gram-negative endophthalmitis. The purpose of this study is to report the clinical features, antibiotic susceptibilities, and treatment outcomes of patients with culture-proven endophthalmitis.
Methods :
This study is a single-center retrospective chart review of all patients with positive vitreous cultures for gram-negative organisms who presented to a referral center from January 2014 to April 2023. All patients with positive vitreous cultures that isolated gram-negative organisms were included. Patients with inadequate records (3) or no-follow up (5) were excluded. This study was approved by the University of Miami Institutional Review Board (IRB Approval #20120897) and conducted in accordance with the Declaration of Helsinki.
Results :
This study included 28 patients (mean age 69.0 years; 57.1% male). The most common isolate was Pseudomonas aeruginosa (14/28, 50.0%), followed by Klebsiella pneumoniae (2/28, 7.1%), Klebsiella aerogenes (2/28, 7.1%) Haemophilus influenzae (2/28, 7.1%), Morganella morganii (2/28, 7.1%), and Citrobacter koseri (2/28, 7.1%). The most common etiologies were post-operative (11/28, 39.3%), trauma (5/28, 17.9%), and corneal ulcer (4/28, 14.3%). All organisms tested were sensitive to ceftazidime (25/25, 100%), tobramycin (24/24, 100%), and ciprofloxacin (24/24, 100%). At the last follow-up, only 10.7% (3/28) of patients had a visual acuity of 5/200 or better, and 35.7% (10/28) of patients had a visual acuity of no light perception. One-quarter of patients underwent enucleation or evisceration during the follow-up course.
Conclusions :
Despite favorable sensitivities to commonly used intravitreal antibiotics, endophthalmitis caused by gram-negative organisms generally has a poor visual prognosis, regardless of causative organisms and etiologies. Enucleation and evisceration were not uncommon despite appropriate treatment with intravitreal antibiotics and/or pars plana vitrectomy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.