Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

Abstract

Background: Examining the effect of antibiotic resistance, use of intravitreal antibiotics and systemic corticosteroids on visual outcome of eyes with acute endophthalmitis. Methods: We included 226 eyes with acute endophthalmitis, treated using a standardized protocol. Visual outcome up to 12 months was assessed related to biopsy results, antibiotics resistance and treatment regimens. Results: Vitreous biopsies were more likely to be culture-positive (41.1%) than anterior chamber biopsies (21.6%, p < 0.0001). Antibiotic resistance for amikacin was found in 19 eyes (24.7%), vancomycin in 29 eyes (31.5%) and moxiflocacin in 14 eyes (16.1%). At presentation 91.53% of eyes had BCVA < 20/40, reducing by 1 month to 69.94% (p < 0.0001) and remaining stable at 12 months. There was no difference in visual outcome for those receiving early systemic corticosteroids. Endophthalmitis following cataract surgery (OR 1.66, 1.04−2.66 95% CI, p = 0.03) and receiving intravitreal vancomycin (OR 3.15, 1.18−8.42 95% CI, p = 0.02) were associated with a greater chance of final BCVA ≥ 20/40. Conclusion: Using vitreous taps with intravitreal antibiotics, despite an increase in resistance to both vancomycin and moxifloxacin, results in a final BCVA > 20/200 in half of eyes and ≥20/40 in a third. Early treatment with intravitreal antibiotics should not be delayed.

Keywords: antibiotic resistance; corticosteroids; endophthalmitis; moxifloxacin; vancomycin.

Figure 1

Change in visual acuity during 12 months following acute endophthalmitis. For the entire cohort, there was a significant and stable improvement in best-corrected visual acuity within one month. BCVA—best-corrected visual acuity, m—months. **—p < 0.01 (one-way ANOVA).

Figure 2

Vision loss patterns following acute endophthalmitis. By 12 months half of eyes had improved to a visual acuity better than 20/200 and a third had no vision loss. **—p < 0.01 (Pearson’s Chi-square test). m—months, MVL—moderate vision loss, SVL—severe vision loss, VL—vision loss.

Figure 3

Change in visual acuity according to etiology. Eyes with endophthalmitis following filtration surgery had significantly less improvement in visual acuity, than eyes following cataract surgery or intravitreal injections. BCVA—best-corrected visual acuity, m—months. *—p < 0.05; **—p < 0.01 (one-way ANOVA).