Management of bacterial postoperative endophthalmitis and the role of vitrectomy

Clarke, Benjamin; Williamson, Tom H.; Gini, Giampaolo; Gupta, Bhaskar

doi:10.1016/j.survophthal.2018.02.003

Cited by 75 publications

(82 citation statements)

References 138 publications

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“…The current landscape of rising antibiotic resistance makes the investigation of newer, more efficacious therapies important for improving clinical outcomes. Delafloxacin is an expensive drug, however, costing approximately $675 for a 5-day course of systemic treatment (compared to $51 for moxifloxacin) [15]. Therefore, future investigations on cost utility of the drug as well as widerscale prospective studies will help define its promising role in the treatment of endophthalmitis.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Current empiric treatment of suspected bacterial endophthalmitis typically begins with intravitreal vancomycin and ceftazidime [1,6,[14][15][16]. Regarding fluoroquinolones, intracameral and systemic treatment has gained interest in light of the favorable safety profile and low MIC levels of some agents like moxifloxacin [15,17]. However, steadily increasing rates of antibiotic resistance to fluoroquinolones among CoNS have been reported (56% nonsusceptibility for ciprofloxacin and levofloxacin, 57% for moxifloxacin) [7], with these resistant microbes conferring poor visual outcomes [18].…”

Section: Discussionmentioning

confidence: 99%

“…The current study examines the in-vitro efficacy of a new fourth-generation fluoroquinolone, delafloxacin, for S. epidermidis and S. aureus endophthalmitis vitreous isolates in a single, tertiary care institution over a 4-year period. Delafloxacin is a promising new antibiotic that targets bacterial topoisomerase IV and DNA gyrase and demonstrates activity against Gram-positive bacteria including MRSA and Gram-negative bacteria such as Pseudomonas aeruginosa (P. aeruginosa) [15]. In vivo pharmacokinetic and pharmacodynamic studies have demonstrated rapid oral absorption of delafloxacin, high bioavailability (60-70%), and renal excretion [19].…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Fan

Lin

Yannuzzi

et al. 2020

J Ophthal Inflamm Infect

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Background: To assess the in-vitro efficacy of delafloxacin, a new fourth generation fluoroquinolone, against Staphylococcus vitreous isolates from patients with clinically diagnosed endophthalmitis. This is the first investigation of delafloxacin in ocular tissues. Methods: Intravitreal isolates of culture-proven S. aureus and S. epidermidis were identified between 2014 and 2018. Minimum inhibitor concentrations (MIC) were determined using ETEST strips. The antibiotic susceptibilities were tested against a panel of drugs including glycopeptides such as vancomycin, as well as traditional and newer fluoroquinolones (levofloxacin, moxifloxacin, and delafloxacin). Results: Of 45 total isolates identified between 2014 and 2018, 13% (6) were methicillin-resistant S. aureus (MRSA), 9% (4) were methicillin-sensitive S. aureus (MSSA), 53% (24) were methicillin-resistant S. epidermidis (MRSE), and 24% (11) were methicillin-sensitive S. epidermidis (MSSE). Among the fluoroquinolones, resistance rates were 61% for levofloxacin, 50% for moxifloxacin, and 12% for delafloxacin. Inter-class comparisons between delafloxacin and the two other fluoroquinolones demonstrated higher Gram-positive susceptibility to delafloxacin (p < 0.01). MIC90 values were lowest for delafloxacin (1.0 μg/mL) compared to levofloxacin (8.0 μg/mL) and moxifloxacin (8.0 μg/mL). Vancomycin was 100% effective against all isolates with MIC90 value of 0.75 μg/mL. Conclusion: Compared to levofloxacin and moxifloxacin, the newer fluoroquinolone delafloxacin demonstrated the lowest MICs values and lowest rates of resistance for Gram-positive in-vitro S. epidermidis and S. aureus vitreous isolates.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Fan

Lin

Yannuzzi

et al. 2020

J Ophthal Inflamm Infect

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“…24 It may also rescue vitreous transparency and reduce or avoid tractional retinal detachment. 25,26 Intravitreal injection enables the rapid and effective delivery of antibiotics, to achieve high local drug concentrations. This allows the antibiotics to target the pathogenic bacteria more effectively, thereby inhibiting bacterial growth and controlling in ammation.…”

Section: Discussionmentioning

confidence: 99%

Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by live abscess

Wang

2020

Preprint

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Backgrounds: Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess.Methods: Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery.Results: Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction.Conclusion: Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

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Early vitrectomy for exogenous endophthalmitis following surgery

Muqit

Mehat²,

Bunce³

et al. 2020

Cochrane Database of Systematic Reviews

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Management of bacterial postoperative endophthalmitis and the role of vitrectomy

Cited by 75 publications

References 138 publications

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

In vitro Susceptibilities of Methicillin-Susceptible and Resistant Staphylococci to Traditional Antibiotics Compared to a Novel Fluoroquinolone

Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by live abscess

Early vitrectomy for exogenous endophthalmitis following surgery

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