Post‐surgical <i>versus</i> post‐intravitreal injection endophthalmitis: changing patterns in causative flora

Ong, Aaron Pin Chien; Te, Nikki Angbue; Zagora, Sophia; Symes, Richard; Yates, William B.; Chang, Andrew; McCluskey, Peter; Simunovic, Matthew P.

doi:10.1111/ceo.13345

Cited by 20 publications

(14 citation statements)

References 22 publications

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“…These shifting trends suggested that age may influence the microbiological spectrum of endophthalmitis. Previous studies demonstrated that streptococcal infection was associated with poor vision outcome in endophthalmitis [36][37][38]; therefore, a higher proportion of streptococcal infections in children, especially in younger children, merits clinical attention. Antibiotic resistance is a topic of concern worldwide.…”

Section: Discussionmentioning

confidence: 99%

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Yang

Lin

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients. Methods Patients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively. Results A total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0-3 years, 16.3% in 4-12 years, and 6.3% in 13-17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%. Conclusion Trauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.

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Section: Discussionmentioning

confidence: 99%

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Yang

Lin

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…(Simunovic et al's study was performed between 2007 and 2010 and Ong et al's study was performed between 2012 and 2017). The authors of this recent study [ 27 ] described a lack of statistically significant difference between both groups, which they justify by the change in causative infection organism, highlighting that S. epidermidis was the most frequent causative organism in endophthalmitis after post-IVI. Between these two studies performed in the same hospital, there was a modification in the protocol management of IVI, more precisely, the implementation of facemask and asking the patient to refrain from talking during the procedures.…”

Section: Discussionmentioning

confidence: 99%

Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes

Cunha

Iglésias

Rocha‐Sousa

et al. 2021

Journal of Ophthalmology

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Purpose. To describe and compare the clinical features and visual outcomes of endophthalmitis following intravitreal injections (IVI), cataract surgery, and pars plana vitrectomy (PPV). Methods. This is a single-centre, retrospective study. All included patients had acute postoperative endophthalmitis secondary to one of these three procedures. Visual acuity (VA), comorbidities, time to presentation, and treatment were assessed. The primary outcome was visual outcome. A poor outcome was considered if final VA was worse than or equal to counting fingers (CF) and a good outcome was classified as VA better than CF. Results. Over 12 years, a total of 61 patients were included. Twenty-seven cases were post-cataract endophthalmitis; twenty-five were post-IVI and nine post-PPV. Endophthalmitis post-PPV had a worse visual outcome (88.9% of patients with VA worse than or equal to CF 95% CI 51.3 to 100.0%) than endophthalmitis following cataract surgery (25.9% of patients with VA worse than or equal to CF 95% CI 11.0 to 39.9%) and the IVI subgroup (44.0% of VA worse than or equal to CF 95% CI 24.0 to 67.0%) ( p = 0.001 and p = 0.047 ). There were no significant differences in the proportion of patients with a poor visual outcome between endophthalmitis following cataract surgery and IVI ( p = 0.171 ). Conclusions. The number of patients with poor visual outcomes following acute endophthalmitis was similar in endophthalmitis following IVI and cataract surgery, but better than endophthalmitis following vitrectomy.

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“…The most commonly isolated microorganisms are coagulase-negative staphylococci (40-70%), Staphylococcus aureus (10-17%), streptococci (5-15%), other Gram-positive cocci including enterococci (5%), as well as Gram-negative bacilli (5-10%) including Haemophilus influenzae and Pseudomonas aeruginosa [5][6][7][8]. The microbiologic spectrum of less common forms like post-traumatic or endogenous endophthalmitis is more varied.…”

Section: Definition and Commonly Isolated Microorganismsmentioning

confidence: 99%

Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics

Brockhaus

Goldblum

Eggenschwiler

et al. 2019

Clinical Microbiology and Infection

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Background: Adjunctive systemic antibiotic therapy for treatment of bacterial endophthalmitis is controversial but common practice due to the severity of the disease. In absence of guidance documents, several antibiotic regimens are being used without applying evidence-based prescribing, thus leading to inappropriate treatment of this serious eye condition. Objectives: To summarize available data on intravitreal penetration of systemically administered antibiotics and to discuss their usefulness from a microbiological and pharmacological point of view. Sources: We performed a systematic PubMed search of studies investigating antibiotic concentrations in the vitreous after systemic administration in humans, and selected animal models. Content: The best-documented agents achieving therapeutic levels in the vitreous are meropenem, linezolid and moxifloxacin. Vancomycin, cefazoline, ceftriaxone, ceftazidime, imipenem and trimethoprim-sulfamethoxazole reach levels justifying their use in specific situations. Available data do not support the use of ciprofloxacin, levofloxacin, aminoglycosides, aminopenicillins, piperacillin, cefepime, and clarithromycin. With very limited but available promising data, the use of daptomycin and rifampicin deserves further investigation. Implications: The choice of the adjunctive systemic antibiotic agent -in situations where considered relevant for treatment -must to date be made on an individual base, considering microbiological aspects as well as operative status and inflammation of the eye. This review

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Post‐surgical versus post‐intravitreal injection endophthalmitis: changing patterns in causative flora

Abstract: S. epidermidis is the most common causative organism. In contrast to other studies, we did not find evidence for an increased odds of Streptococcus spp. endophthalmitis following intravitreal injection. This may in turn reflect guideline-driven changes in practice.

Cited by 20 publications

References 22 publications

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Endophthalmitis following Intravitreal Injection, Cataract Surgery, and Vitrectomy: Clinical Features and Visual Outcomes

Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics

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