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Microbiology and visual outcomes of culture-positive bacterial endophthalmitis in Oxford, UK

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Abstract

Purpose

To review the microbiology of culture-positive cases of bacterial endophthalmitis, and to correlate this with visual outcomes.

Method

Case notes were reviewed for culture-positive cases of bacterial endophthalmitis over a period from November 1999 to June 2012. Cases were identified retrospectively using a local database. The Fisher exact test was used for statistical analysis.

Results

Of the 47 cases of culture-positive bacterial endophthalmitis identified, 81 % occurred postoperatively, 11 % followed intravitreal injection, 6 % had an endogenous source and 2 % followed ocular trauma. Eighty-seven percent of bacteria cultured were Gram-positive. The most commonly identified organisms were coagulase-negative Staphylococci (47 %) and Streptococcus spp. (30 %). Patients were treated with intravitreal vancomycin and either amikacin or ceftazidime. All Gram-negative isolates were sensitive to aminoglycosides and ceftazidime, and all Gram-positive isolates were vancomycin-sensitive. Final visual acuity (VA) was 6/12 or better in 41 % of cases and counting fingers (CF) or worse in 30 %. Endophthalmitis caused by Streptococcus spp. was associated with a poorer final VA (OR for CF or worse = 14.9, P < 0.01). Cases caused by coagulase-negative Staphylococci had a better visual outcome (OR for VA of 6/12 or better = 5.7, P = 0.013). Five eyes were eviscerated or enucleated. Infection with Haemophilus influenzae was strongly associated with this outcome (OR = 57, P < 0.01).

Conclusion

Over the time period of this study there was no evidence of emerging resistance to empirical antibiotics which are commonly used for the treatment of bacterial endophthalmitis. Infection with coagulase-negative Staphylococci was associated with a good visual outcome, whilst infection with Streptococcus spp. or Haemophilus influenzae was associated with a poor visual outcome.

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References

  1. Keynan Y, Finkelman Y, Lagace-Wiens P (2012) The microbiology of endophthalmitis:global trends and a local perspective. Eur J Clin Microbiol Infect Dis 31(11):2879–2886

    Article  CAS  PubMed  Google Scholar 

  2. Simunovic MP, Rush RB, Hunyor AP, Chang AA (2012) Endophthalmitis following intravitreal injection versus endophthalmitis following cataract surgery: clinical features, causative organisms and post-treatment outcomes. Br J Ophthalmol 96(6):862–866

    Article  PubMed  Google Scholar 

  3. Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 113(12):1479–1496

    Article  Google Scholar 

  4. Cheng JH, Chang YH, Chen CL, Chen YH, Lu DW, Chen JT (2010) Acute endophthalmitis after cataract surgery at a referral centre in Northern Taiwan: review of the causative organisms, antibiotic susceptibility, and clinical features. Eye (Lond) 24(8):1359–1365

    Article  Google Scholar 

  5. Recchia FM, Busbee BG, Pearlman RB, Carvalho-Recchia CA, Ho AC (2005) Changing trends in the microbiological aspects of postcataract endophthalmitis. Arch Ophthalmol 123(3):341–346

    Article  PubMed  Google Scholar 

  6. Brown DFJ, Kothari D (1978) Antimicrobial-susceptibility testing of rapidly growing pathogenic bacteria. II A field trial of four disc-diffusion methods J Antimicrob Chemother 4:27–38

    Article  CAS  PubMed  Google Scholar 

  7. Melo GB, Bispo PJ, Yu MC, Pignatari AC, Hofling-Lima AL (2011) Microbial profile and antibiotic susceptibility of culture-positive bacterial endophthalmitis. Eye (Lond) 25(3):382–387

    Article  CAS  Google Scholar 

  8. Ng JQ, Morlet N, Pearman JW, Constable IJ, McAllister IL, Kennedy CJ et al (2005) Team EPSWA. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)’s fifth report. Ophthalmology 112(7):1199–1206

    Article  PubMed  Google Scholar 

  9. Benz MS, Scott IU, Flynn HW Jr, Unonius N, Miller D (2004) Endophthalmitis isolates and antibiotic susceptibilities: a 6-year review of culture-proven cases. Am J Ophthalmol 137(1):38–42

    Article  PubMed  Google Scholar 

  10. Kunimoto DY, Das T, Sharma S, Jalali S, Majji AB, Gopinathan U, Athmanathan S, Rao TN (1999) Microbiologic spectrum and susceptibility of isolates: part I. Postoperative endophthalmitis. Endophthalmitis Research Group. Am J Ophthalmol 128(2):240–242

  11. Sadaka A, Durand ML, Gilmore MS (2012) Bacterial endophthalmitis in the age of outpatient intravitreal therapies and cataract surgeries: host microbe interactions in intraocular infection. Prog Retin Eye Res 31(4):316–331

  12. Moss JM, Sanislo SR, Ta CN (2009) A prospective randomized evaluation of topical gatifloxacin on conjunctival flora in patients undergoing intravitreal injections. Ophthalmology 116:1498–1501

  13. Speaker MG, Milch FA, Shah MK et al (1991) Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 98:639–649

    Article  CAS  PubMed  Google Scholar 

  14. Dickey JB, Thompson KD, Jay WM (1991) Anterior chamber aspirate cultures after uncomplicated cataract surgery. Am J Ophthalmol 112:278–282

    Article  CAS  PubMed  Google Scholar 

  15. Tervo T, Ljungberg P, Kautiainen T et al (1999) Prospective evaluation of external ocular microbial growth and aqueous humor contamination during cataract surgery. J Cataract Refract Surg 25:65–71

    Article  CAS  PubMed  Google Scholar 

  16. ESCRS Endophthalmitis Study Group (2007) Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg 33:978–988

    Article  Google Scholar 

  17. Friling E, Lundstrom M, Stenevi U, Montan P (2013) Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg 39(1):15–21

    Article  PubMed  Google Scholar 

  18. Gilbert DN, Moellering RC, Eliopoulos GM, Sande MA (2007) The Sanford guide to antimicrobial therapy. Antimicrobial Therapy Inc., Sperryville, pp 67–68

    Google Scholar 

  19. Deramo VA, Lai JC, Winokur J, Luchs J, Udell IJ (2008) Visual outcome and bacterial sensitivity after methicillin-resistant Staphylococcus aureus associated acute endophthalmitis. Am J Ophthalmol 145(3):413–417

    Article  PubMed  Google Scholar 

  20. Major JC Jr, Engelbert M, Flynn HW Jr, Miller D, Smiddy WE, Davis JL (2010) Staphylococcus aureus endophthalmitis: antibiotic susceptibilities, methicillin resistance, and clinical outcomes. Am J Ophthalmol 149(2):278–283

    Article  CAS  PubMed  Google Scholar 

  21. Cavuoto K, Zutshi D, Karp CL, Miller D, Feuer W (2008) Update on bacterial conjunctivitis in South Florida. Ophthalmology 115(1):51–56

    Article  PubMed  Google Scholar 

  22. Haas W, Pillar CM, Torres M, Morris TW, Sahm DF (2011) Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular microrganisms (ARMOR) 2009 surveillance study. Am J Ophthalmol 152(4):567–574

    Article  CAS  PubMed  Google Scholar 

  23. Tan CSH (2007) Prophylaxis against endopthalmitis in cataract surgery. Ann Acad Med Singapore 36(Suppl):40–44

    CAS  Google Scholar 

  24. Ou JI, Ta CN (2006) Endophthalmitis prophylaxis. Ophthalmol Clin North Am 19:449–456

    PubMed  Google Scholar 

  25. Garat M, Moser CL, Onso-Tarres C, Martin-Baranera M, Alberdi A (2005) Intracameral cefazolin to prevent endophthalmitis in cataract surgery: 3- year retrospective study. J Cataract Refract Surg 31:2230–2234

    Article  PubMed  Google Scholar 

  26. Montan PG, Wejde G, Koranyi G, Rylander M (2002) Prophylactic intracameral cefuroxime. Efficacy in preventing endophthalmitis after cataract surgery J Cataract Refract Surg 28:977–981

    Article  PubMed  Google Scholar 

  27. Mamalis N, Kearsley L, Brinton E (2002) Postoperative endophthalmitis. Curr Opin Ophthalmol 13(1):14–8

    Article  PubMed  Google Scholar 

  28. Yoder DM, Scott IU, Flynn HW Jr, Miller D (2004) Endophthalmitis caused by Haemophilus influenzae. Ophthalmology 111(11):2023–2026

    Article  PubMed  Google Scholar 

  29. Alvarez O, Morales J, McCartney DL et al (1991) Haemophilus aphrophilus endophthalmitis associated with a filtering bleb. Arch Ophthalmol 109:618–620

    Article  CAS  PubMed  Google Scholar 

  30. Macken PL, Boyd SR, Campbell I et al (1995) Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy. Aust N Z J Ophthalmol 23:323–325

    Article  CAS  PubMed  Google Scholar 

  31. Greenfield DS, Suner IJ, Miller MP et al (1996) Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol 114:943–949

    Article  CAS  PubMed  Google Scholar 

  32. Recchia FM, Baumal CR, Sivalingam A et al (2000) Endophthalmitis after pediatric strabismus surgery. Arch Ophthalmol 118:939–944

    CAS  PubMed  Google Scholar 

  33. Thorne JE, Maguire AM (2000) Hemophilus aegyptius endophthalmitis following strabismus surgery. J Pediatr Ophthalmol Strabismus 37:52–53

    CAS  PubMed  Google Scholar 

  34. Lewis JM, Eliott D (1998) Extrusion of an anterior chamber intraocular lens complicated by Haemophilus endophthalmitis. Am J Ophthalmol 125:261–263

    Article  CAS  PubMed  Google Scholar 

  35. Miller JJ, Scott IU, Flynn HW Jr et al (2004) Endophthalmitis caused by Streptococcus pneumoniae. Am J Ophthalmol 138:231–236

    Article  PubMed  Google Scholar 

  36. Moshfeghi AA, Rosenfeld PJ, Flynn HW Jr et al (2011) Endophthalmitis after intravitreal anti-vascular endothelial growth factor antagonists: a six-year experience at a University Referral Center. Retina 31:662–668

    Article  CAS  PubMed  Google Scholar 

  37. Wong TY, Chee SP (2004) The epidemiology of acute endophthalmitis after cataract surgery in an Asian population. Ophthalmology 111(4):699–705

    Article  PubMed  Google Scholar 

  38. Bispo PJ, de Melo GB, Hofling-Lima AL, Pignatari ACC (2011) Detection and Gram discrimination of bacterial pathogens from aqueous and vitreous humor using real-time PCR assays. Invest Ophthalmol Vis Sci 52:873–881

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. c/o SJ Hornby, Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK

    A. Gupta

  2. Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK

    H. O. Orlans & S. J. Hornby

  3. Department of Microbiology, John Radcliffe Hospital, Oxford, UK

    I. C. J. W. Bowler

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  1. A. Gupta
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  2. H. O. Orlans
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  3. S. J. Hornby
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  4. I. C. J. W. Bowler
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Correspondence to A. Gupta.

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Gupta, A., Orlans, H.O., Hornby, S.J. et al. Microbiology and visual outcomes of culture-positive bacterial endophthalmitis in Oxford, UK. Graefes Arch Clin Exp Ophthalmol 252, 1825–1830 (2014). https://doi.org/10.1007/s00417-014-2658-7

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  • DOI: https://doi.org/10.1007/s00417-014-2658-7

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