Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15-year review

Moloney, Thomas P; Park, Joseph

doi:10.1136/bjophthalmol-2014-305030

Cited by 66 publications

(52 citation statements)

References 19 publications

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“…Among those that were culture‐confirmed, 96% were Gram positive, with Staphylococcus species (including MRSA and MSSA) accounting for 66% of organisms and MRSA itself making up 8% of isolates. Our finding that only 4% of isolates were Gram negative corresponds to previous reports . Sensitivity results from our study correspond to prior literature showing that both MRSA and MSSA have greater in vitro sensitivity to gentamicin than fluoroquinolones .…”

Section: Discussionsupporting

confidence: 92%

“…The injection of intracameral antibiotics has been shown to decrease the rate of endophthalmitis in cataract surgery . Topical antibiotics are intended to reduce conjunctival bacterial load that is predominantly composed of CoNS . We showed a 42% reduction in endophthalmitis associated with intracameral antibiotic compared with topical antibiotic, whereas no use of antibiotic prophylaxis was associated with a 95% increase in risk compared with use of topical antibiotic .…”

Section: Introductionmentioning

confidence: 75%

“…The most common causative organisms are Gram positive, such as coagulase‐negative Staphylococcus (CoNS), Streptococcus viridans or Staphylococcus aureus . Gram‐negative organisms, such as Pseudomonas or Haemophilus , are less common; fungi are rare …”

Section: Introductionmentioning

confidence: 99%

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Pathogens and antibiotic sensitivities in endophthalmitis

Slean

Shorstein

Liu

et al. 2017

Clinical Exper Ophthalmology

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BACKGROUND Antibiotic prophylaxis in cataract surgery is intended to minimize endophthalmitis. We describe pathogenic organisms, antibiotic sensitivities, and antibiotic prophylaxis in culture-proven endophthalmitis cases. DESIGN Retrospective consecutive case series, community-based setting. SAMPLES 215 cases of endophthalmitis after cataract surgery performed during 2007–2012 in Kaiser Permanente, California. METHODS AND MAIN OUTCOME MEASURES Descriptive analysis of isolated organisms and antibiotic sensitivities in relation to antibiotic prophylaxis in culture-proven endophthalmitis cases. RESULTS The majority of culture-confirmed organisms (N=83) were Gram-positive (96%), most notably coagulase-negative Staphylococci (CoNS) (N=34, 52%), of which all that underwent testing were sensitive to vancomycin (N=32). Among 19 cases that had received only topical antibiotic prophylaxis, 7 (37%) were resistant to the antibiotic given: 50% of cases (5 of 10 isolates) that had received ofloxacin were resistant to this antibiotic, 40% (2 of 5 isolates) that had received gatifloxacin were resistant. In contrast, 100% of cases (N=4) that had received aminoglycosides were susceptible. Few culture-confirmed cases occurred in patients who received intracameral antibiotic (N=4). CONCLUSIONS In cases where fluoroquinolones were administered as antibiotic prophylaxis, isolates demonstrated a degree of bacterial resistance. The majority of endophthalmitis cases isolated following topical antibiotic prophylaxis only and were attributed to Gram-positive organisms, while few occurred in association with intracameral antibiotic.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 75%

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Pathogens and antibiotic sensitivities in endophthalmitis

Slean

Shorstein

Liu

et al. 2017

Clinical Exper Ophthalmology

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“…Others have found similar results and have highlighted the poor visual outcomes associated with this virulent pathogen, with an increased likelihood of a final VA of counting fingers or less and an increased likelihood of enucleation [14, 16, 17, 21, 64]. …”

Section: Reviewmentioning

confidence: 69%

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Merani

Hunyor

2015

Int J Retin Vitr

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The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure’s possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.

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“… UPMC = University of Pittsburgh Medical Center; NYEEI = New York Eye and Ear Infirmary 6 ; BPEI = Bascom Palmer Eye Institute 7 ; Hyderabad, India 12 ; Queensland, Australia 8 …”

Section: Tablementioning

confidence: 99%

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

Kodati

Eller

Kowalski

2017

Ophthalmology Retina

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Purpose To investigate the in vitro susceptibility of Gram-positive and Gram-negative endophthalmitis bacterial isolates to vancomycin, amikacin, and ceftazidime over a 23-year period. Design Retrospective non-comparative laboratory case series. Subjects Endophthalmitis patients that were culture positive for bacteria. Methods Laboratory records of bacteria isolated from endophthalmitis specimens collected from January 1st 1993 to December 31st 2015 were reviewed for incidence and standard susceptibility testing. Main outcome measures The in vitro susceptibilities of bacteria cultured from endophthalmitis to vancomycin (VAN), amikacin (AMK), and ceftazidime (CEF). Results Patients with endophthalmitis were culture positive for bacteria in 665 cases.. Coagulase negative Staphylococci (CoNS) were the most common bacteria (54.6%), followed by Streptococci (Strep) species (20.8%), Staphylococcus aureus (SA) (10.2%), other Gram-positive (other-GP) bacteria (7.4%) and Gram-negative (GN) bacteria (7.1%). All Gram-positive organisms were susceptible to VAN, with the exception of 2 isolates. The in vitro susceptibilities of bacteria to AMK were: CoNS (95.3%), SA (75.0%), Strep (8.0%), GN (95.7%), and other-GP (81.1%). The in vitro susceptibilities of bacteria to CEF were: CoNS (58.5%), SA (54.4%), Strep (84.1%), GN (93.6.%), and other-GP (52.8%). There was no difference between AMK (95.7%) and CEF (93.6%) for GN coverage. AMK provided better coverage than CEF for CoNS, SA, and other-GP bacteria respectively (p<0.05, Fisher's exact), however, CEF appeared to provide better coverage (p<0.001, Fisher's exact) for Strep than AMK. Conclusions Based on standard in vitro susceptibility testing, vancomycin remains an optimal antibiotic choice for the treatment of Gram-positive endophthalmitis. AMK and CEF appear to provide equal GN coverage, but AMK appears to provide better coverage for CoNS, SA, and other-GP, but not Strep.

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Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15-year review

Cited by 66 publications

References 19 publications

Pathogens and antibiotic sensitivities in endophthalmitis

Pathogens and antibiotic sensitivities in endophthalmitis

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

The Susceptibility of Bacterial Endophthalmitis Isolates to Vancomycin, Ceftazidime, and Amikacin: A 23-Year Review

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