Assessment of a standard treatment protocol on visual outcome following presumed bacterial endophthalmitis

Abstract

Aims-The aim of this prospective study was, firstly, to judge the eVect of early aggressive treatment with a standardised regimen of high dose broad spectrum intraocular and systemic antibiotics on visual outcome and, secondly, to assess the sensitivity of isolated organisms to the treatment regimen utilised. Methods-Thirty two consecutive patients presenting with presumed bacterial endophthalmitis were treated and completed follow up. In every case, intraocular sampling was undertaken and treatment with intraocular vancomycin, amikacin, and systemic ciprofloxacin was commenced immediately, followed by systemic steroids 1 day later. Results-In 69% of patients vision improved with 47% achieving a final visual acuity of 6/36 or better and 31% achieving 6/12 or better. Of the intraocular samples taken from post-surgical and posttraumatic cases, 10/27 (37%) and 3/5 (60%) were culture positive, respectively. All the bacteria isolated were sensitive to at least one of the three antibiotics used. Conclusions-The study demonstrated that the combination of vancomycin, amikacin, and ciprofloxacin is adequate as a standard regimen for the treatment of most patients with suspected bacterial endophthalmitis. The prognosis for a good visual outcome, however, remains poor with 15/27 (55%) post-surgical and 2/5 (40%) post-traumatic cases achieving a final acuity of 6/60 or less.

Identification of Polybacterial Communities in Patients with Postoperative, Posttraumatic, and Endogenous Endophthalmitis through 16S rRNA Gene Libraries

“…Out of 40 samples investigated for bacteria, 10 produced negative results by both the culture and PCR methods (Table 1). Such negative results may be due to the sequestration of bacteria on solid surfaces (e.g., intraocular lens, lens remnants, and capsule) leading to low numbers in the liquid sample, prior antibiotic administration, or nonbacterial infection (9,14,15,32). Culture-independent methods, like DGGE or 16S rRNA gene libraries, are relatively good, and the latter has proved to be more efficient for analyzing bacterial diversity (33).…”

“…Even with the most appropriate laboratory practices, the culture method has identified etiologies only in 34 to 65% of the clinical cases (10)(11)(12). This is often because of small sample volume, low bacterial load, prior use of antibiotics, and the fastidious nature of microorganisms (9,11,(13)(14)(15). On the other hand, although 16S rRNA gene PCR efficiently identifies monomicrobial infection, mixed PCR amplicons of polymicrobial infection cannot be sequenced (13) without cloning or next-generation sequencing methodologies.…”

Bacterial Endophthalmitis: Epidemiology, Therapeutics, and Bacterium-Host Interactions

“…Unfortunately, clinical features of infection and culture results often do not correlate adequately to guide the choice of antibiotics upon presentation (65). Furthermore, despite coverage with broad-spectrum antibiotics, visual loss remains a common result (36,98). Outcome of endophthalmitis management is likely due to several factors, including the responsible pathogen, the patient's age, the duration between injury and treatment, the therapy chosen, and the condition of the eye upon presentation (43).…”

Surveillance of endophthalmitis following cataract surgery in the UK

“…17 Following the results of recent studies, 6,18 it is now accepted that direct injection of antibiotics into the vitreous cavity is the most consistent method of achieving adequate intraocular levels for the treatment of suspected infectious endophthalmitis.…”