Acute-Onset Endophthalmitis After Cataract Surgery

Altan, Tugrul; Acar, Nur; Kapran, Ziya; Ünver, Yaprak Banu; Yurttaser, Serap; Küçüksümer, Yaşar; Eser, İlker

doi:10.1097/iae.0b013e3181953a31

Cited by 29 publications

(11 citation statements)

References 22 publications

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“…The Indian studies, at 26% to 42%, have reported higher incidences of Gram-negative bacterial infection [1,2]. Similarly, in a report from Turkey, a higher rate of Gram-negative bacteria was reported at 35.1% of cases [3]. …”

Section: Resultsmentioning

confidence: 99%

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Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Jindal

Pathengay

Khera

et al. 2013

J Ophthal Inflamm Infect

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BackgroundThe purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.ResultsSixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients.ConclusionIn the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

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Section: Resultsmentioning

confidence: 99%

“…Gram-negative organisms have been isolated in 26% to 42% of patients with cataract surgery related to endophthalmitis in developing countries [1-3] as compared to 5.9% to 12.2% in developed countries [4-12]. The common Gram-negative organisms causing endophthalmitis include species of Pseudomonas , Haemophilus, Klebsiella , and Proteus .…”

Section: Introductionmentioning

confidence: 99%

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Jindal

Pathengay

Khera

et al. 2013

J Ophthal Inflamm Infect

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“…5 As described in the Turkey-based study, the lack of association between systemic antibiotic use and good visual outcomes in our study does not necessarily mean that systemic antibiotics do not have any role in the management of postoperative endophthalmitis. 12 Our study was purely observational, and therefore, we cannot make direct inferences regarding the comparative effectiveness of different treatment approaches.…”

Section: Discussionmentioning

confidence: 98%

“…The EVS reported that systemic antibiotics did not improve visual acuity. 4 Similarly, a single-center retrospective evaluation of 88 cases in Turkey showed no benefit of systemic antibiotics, 12 whereas the EPSWA found a nearly 4-fold increased risk of visual acuity worse than 6/18 (equivalent to 20/60) in patients not treated with systemic antibiotics. 5 However, within that study, 22% of the 107 eyes included in the multivariate analysis did not receive intravitreal antibiotics for endophthalmitis management, which may alter the benefits of systemic antibiotics significantly.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population

et al. 2015

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Purpose Endophthalmitis is a rare but sight-threatening infection after cataract surgery. Roughly one third of eyes remain blind after treatment. We report United States population-based data on microbiological investigations and treatment patterns plus risk factors for poor outcomes. Design Retrospective cohort study. Participants Medicare beneficiaries from 5 states in whom endophthalmitis developed within 6 weeks after cataract surgery in 2003 and 2004. Methods We identified endophthalmitis cases occurring after cataract surgery using Medicare billing claims. We contacted treating physicians and requested they complete a questionnaire on clinical and microbiological data and submit relevant medical records. Two independent observers reviewed materials to confirm that cases met a standardized definition. Main Outcome Measures Positive culture results, vitrectomy status, microbiology spectrum, and final visual acuity. Results In total, 615 cases met our case definition. Initial visual acuity was counting fingers or worse for 72%. Among 502 cases with known culture results, 291 (58%) had culture positive results. Twelve percent had positive results for streptococci. More than 99% of cases were treated with intravitreal vancomycin. Vitrectomy was performed in 279 cases (45%), including 201 cases with initial acuity better than light perception. Rates of vitrectomy varied across states, with California having the highest rate and Michigan having the lowest (56% and 19% of cases, respectively). Overall, 43% of individuals achieved visual acuity of 20/40 or better. Poor initial acuity (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04–1.12 per 0.10 logarithm of the minimum angle of resolution units), older age at diagnosis (OR, 1.22; 95% CI, 1.03–1.45 per 5-year increase), and more virulent organisms were important predictors of poor final visual acuity. Cases with streptococci infection were 10 times more likely to have poor final acuity than coagulase-negative staphylococci cases (adjusted OR, 11.28; 95% CI, 3.63–35.03). Vitrectomy was not predictive of final visual acuity (adjusted OR, 1.26; 95% CI, 0.78–2.04). Conclusions Population-based data on the microbiology of acute postoperative endophthalmitis in the United States after cataract surgery are consistent with prior reports. Vitrectomy usage is higher than that recommended from the Endophthalmitis Vitrectomy Study, with no evidence of increased benefit.

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“…Less virulent organisms, such as Staphylococci , are associated with better initial visual acuity and final visual outcome [2,12,13]. The association of the virulence of microorganisms with poor visual outcome is proven in several studies [14-17]. …”

Section: Discussionmentioning

confidence: 99%

Late-Onset Citrobacter koseri Endophthalmitis with Suture Exposure after Secondary Intraocular Lens Implantation

Kang

Chung²

2011

Korean J Ophthalmol

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A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.

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Acute-Onset Endophthalmitis After Cataract Surgery

Abstract: Pars plana vitrectomy may be preferable to IOAI in postoperative endophthalmitis since the rate of early reintervention is lower with initial PPV.

Cited by 29 publications

References 22 publications

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population

Late-Onset Citrobacter koseri Endophthalmitis with Suture Exposure after Secondary Intraocular Lens Implantation

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