Endophthalmitis Caused by Streptococcal Species: Clinical Settings, Microbiology, Management, and Outcomes

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• 作者：Ajay E. Kuriyan ; ^{akuriyan@med.miami.edu" class="auth_mail}Author Vitae ; Kathleen D. Weiss ; Harry W. Flynn Jr. ; William E. Smiddy ; Audina M. Berrocal ; Thomas A. Albini ; Darlene Miller
• 刊名：American Journal of Ophthalmology
• 出版年：April, 2014
• 年：2014
• 卷：157
• 期：4
• 页码：774-780.e1
• 全文大小：492 K

文摘

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Purpose

To report the clinical settings, antibiotic susceptibilities, and outcomes of endophthalmitis caused by <em>Streptococcusem> species.

Design

Retrospective, observational case series.

Methods

Single-center study evaluating all patients with culture-positive endophthalmitis caused by <em>Streptococcusem> species between January 1, 2000, and December 31, 2011.

Results

Study criteria were met by 63 patients. The most common clinical settings were bleb associated (n聽= 17; 27%), after intravitreal injection (n聽= 16; 25%), and after cataract surgery (n聽= 13; 21%). The isolates were <em>Streptococcus viridansem> (n聽= 47; 71%), <em>Streptococcus pneumoniaeem> (n聽= 13; 21%), and 尾-hemolytic <em>Streptococciem> (n聽= 5; 8%). Sixty (95%) of 63 isolates were susceptible to vancomycin, 47 (98%) of 48 isolates were susceptible to ceftriaxone (third-generation cephalosporin), and 57 (93%) of 61 isolates were susceptible to levofloxacin (third-generation fluoroquinolone). Between the first and second half of the study, the minimal inhibitory concentration of antibiotics required to inhibit 90% of isolates increased by 1.5-fold for ceftriaxone and 2-fold for levofloxacin and remained the same for vancomycin. Initial treatment was vitreous tap (49; 78%) or pars plana vitrectomy (14; 22%); all received intravitreal antibiotics. Visual acuity outcomes were variable: best-corrected visual acuity was 20/400 or better in 16 (25%) patients and worse than 20/400 in 47 (75%) patients. Evisceration or enucleation was performed in 16 (25%) patients.

Conclusions

<em>Streptococcusem> isolates generally had high susceptibility rates to commonly used antibiotics. Higher antibiotic minimal inhibitory concentrations were required to inhibit 90% of isolates in聽vitro in the second half of the study period compared with the first half. Despite prompt treatment, most patients had poor outcomes.