Persistently Vitreous Culture-Positive Exogenous Bacterial Endophthalmitis

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• 作者：Ella H. Leung ; Ajay E. Kuriyan ; Harry W. Flynn Jr. ; ^{hflynn@med.miami.edu" class="auth_mail" title="E-mail the corresponding author} ; Darlene Miller ; Laura C. Huang
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：165
• 期：Complete
• 页码：16-22
• 全文大小：166 K

文摘

To report the clinical settings, bacterial isolates, antibiotic sensitivities, and visual acuity outcomes of patients with persistently positive vitreous cultures after intravitreal antibiotics.

Design

Consecutive, noncomparative case series.

Methods

setting: Tertiary care center. patient population: Thirty-six eyes of 36 patients with exogenous endophthalmitis with the same bacterial organism identified on at least 2 consecutive vitreous cultures from 1981 to 2015. observation procedures: Vitreous cultures with intravitreal injections of antibiotics and pars plana vitrectomies with intravitreal antibiotics. main outcome measures: Bacterial isolates, antibiotic sensitivities, visual outcomes.

Results

Thirty-six eyes of 36 patients met the study criteria. The mean follow-up was 26.5 months. The most common clinical settings were after cataract extraction (18/36, 50%) and glaucoma surgery (11/36, 31%). The mean initial visual acuity was 2.16 ± 0.77 logMAR (Snellen equivalent ≈20/2900), and there was no statistically significant change at the final evaluation (2.08 ± 0.97 logMAR, ≈20/1900, P = .72). The most common bacteria were Staphylococcus (11/36, 31%) and Streptococcus (9/36, 25%). Gram-positive bacteria were sensitive to vancomycin (27/27, 100%); gram-negative bacteria were sensitive to amikacin (5/5, 100%). The antibiotic sensitivities were the same on repeat cultures in 34 of 36 patients (94%). The initial treatment was a vitreous culture and intravitreal injection of antibiotics in 28 of 36 patients (78%). The vision at the last follow-up was 20/200 or better in 12 patients (33%) and no light perception in 11 of 36 patients (31%).

Conclusions

The most commonly identified organisms were gram-positive bacteria. There was good concordance in the antibiotic sensitivities between initial and subsequent cultures. Patients with persistently vitreous culture–positive endophthalmitis had poor visual outcomes.