Infectious Endophthalmitis: An Overview of Clinical Features, Microbiology Profile, and Antibiotic Sensitivity Pattern

Abstract

Purpose: To describe the demographic characteristics, etiology, microbiological spectrum, and antibiotic sensitivity patterns in patients with endophthalmitis.

Methods: This is a retrospective case series spanning from May 2012 to September 2018. All included patients were diagnosed with endophthalmitis and confirmed by laboratory tests. Data were collected on patient demographics, types of endophthalmitis, and microbiologic and medical records.

Results: Nine hundred ninety-two records of patients with endophthalmitis were assessed. Of the total cases, 657 patients (66.2%) were male, whereas 335 (33.8%) were female. The mean age of the patients was 57.2 ± 22.8 years and ranged from 2 to 95 years. The type of endophthalmitis was acute postcataract surgery (44.4%), posttraumatic (26.7%), chronic postcataract surgery (6.6%), endogenous (6.4%), postintravitreal injection (5.0%), keratitis-associated (3.6%), postvitrectomy (2.7%), bleb-associated (2.4%), postkeratoplasty (1.9%), and device-related (0.1%). The most frequently isolated organisms were Staphylococcus epidermidis (11.7%), followed by Streptococcus pneumoniae (5.2%) and Streptococcus viridans (5.1%). Antibiotic susceptibility testing in patients with acute postcataract surgery endophthalmitis showed variable sensitivity of S. epidermidis isolates to vancomycin (81.4%), ciprofloxacin (76.2%), and levofloxacin (75.0%). In patients with posttraumatic endophthalmitis, high rates of zone 1 injury (61.5%), traumatic cataract (67.9%), and intraocular foreign body (IOFB) (29.8%) were observed.

Conclusions: S. epidermidis is the most common causative pathogen in patients with endophthalmitis, its increasing resistance to vancomycin and fluoroquinolones may pose some challenges to the treatment of endophthalmitis in the future. Regarding the presence of IOFB, zone 1 injury, and traumatic cataracts that might be associated with an increased risk of posttraumatic endophthalmitis, it is better to consider these aspects in penetrating eye injuries.

Keywords: Endophthalmitis; Fluoroquinolones; Intravitreal injections; Keratitis; Ocular trauma; Penetrating eye injuries; Staphylococcus epidermidis; Streptococcus pneumoniae; Vancomycin; Vitrectomy.

Figure 1

Distribution of endophthalmitis

Figure 2

The prevalence of isolated pathogens before and after 2015