Pathogens and antibiotic sensitivities in endophthalmitis

Abstract

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.

<p>Antibiotic resistance among ocular pathogens: current trends from the ARMOR surveillance study (2009&ndash;2016)</p>

“…In vitro resistance rates and susceptibility profiles in the present study are similar to reported data for bacterial isolates with specific ocular diagnoses, such as conjunctivitis,44 keratitis,12,45 and endophthalmitis 13,15,17. In a 20-year review of antibiotic resistance among 398 S .…”

Infectious Endophthalmitis: Trends in Microbiology, Management, and Surgical Techniques

“…8,9 When broken down further within gram-positives, coagulase-negative staphylococci (CoNS), which include S. epidermidis, comprise 54.6%, while Streptococcus species (20.8%), Staphylococcus aureus (10.2%), and other gram-positives (7.4%) are also frequently isolated. [9][10][11] Fungi and yeast make up 8.4% of isolates. 8 International studies have found similar results and microbiological spectrum in most countries throughout the world, including the United States (US), Australia, and European nations.…”

“…Most cases of antibiotic resistance occur following the use of topical prophylaxis, and only rarely following IC prophylaxis. 10 Over the past several decades, the rates of methicillinresistant S. aureus and resistant S. pneumonia have risen significantly, with methicillin resistance seen in 34.6% to 41.6% of S. aureus endophthalmitis infections. 63 In 2015, the Antibiotic Resistance Monitoring in Ocular Microorganisms Surveillance Study 64 published susceptibility findings from isolates of the most common organisms that had been sent from clinical centers throughout the US.…”

Macular ischemia after intravitreal amikacin on patient with intraocular foreign body

“…To provide adequate Gram-negative and -positive bacterial cover in endophthalmitis cases, a currently accepted therapeutic regimen includes aminoglycosides [6]. In developing countries, aminoglycosides have become a favorable drug of choice due to their ease of access and reduced cost.…”

“…However, these treatments are not without side effects: retinal vascular infarction is commonly described after gentamicin administration, and has been noted after use of amikacin [7]. While previously noted as a rare complication, the reported frequency of macular ischemia following amikacin intravitreal injection for the treatment of endophthalmitis has increased recently [6], [8]. This report describes a case of macular ischemia following intravitreal amikacin injection.…”