Abstract
The spectrum of microbial infections and the pattern of their susceptibility are variable among communities. Researching these data will lead to the establishment of the most appropriate national management strategies. The purpose of this study was to analyze the epidemiological, clinical, microbial spectrum and antibiotic susceptibility of endophthalmitis cases in a tertiary referral center in Jerusalem. Retrospective review of medical charts of patients presenting with endophthalmitis over a 12-year period. A total of 74 eyes of 70 patients (males 56%) were included. Mean age ± SD at presentation was 60 ± 19.5years. Exogenous endophthalmitis accounted for 78% of cases, of which 62% followed an intraocular surgery, 21% occurred after intravitreal injections, 10% followed infectious keratitis and 7% were posttraumatic. Endogenous cases were predominantly observed in diabetic patients. Microbial isolates were identified in 44 samples. Of them, gram-positive bacteria were the predominant microorganisms detected in 33 samples (75%); Staphylococcus epidermidis and Enterococcus faecalis were the most commonly detected pathogens. Mean presenting ± SD LogMAR visual acuity (VA) was 2.38 ± 1.21 and it improved at last follow-up to 1.7 ± 1.37 (p = 0.004, paired t test). Cases secondary to gram-positive microbes were associated with improved VA during the follow-up while cases secondary to gram-negative microbes was correlated with poor final VA (p = 0.046, r2 = 0.4). There was no evidence of bacterial resistance in the antibiograms for either vancomycin, ceftazidime, ceftriaxone or amikacin. Intraocular surgery remains the most common event preceding endophthalmitis with coagulase-negative staphylococci being the most frequently detected microorganisms. The microbial spectrum of endophthalmitis is similar to that in the western world.
Highlights
Endophthalmitis is one of the most dreadful entities in Ophthalmology
There was no evidence of bacterial resistance in the antibiograms for either vancomycin, ceftazidime, ceftriaxone or amikacin
Data retrieved from the medical files included demographic features, year of presentation, type of endophthalmitis, the inciting event in exogenous cases and the underlying illnesses in exogenous and endogenous endophthalmitis, systemic and local therapy, surgical management including lapse of time between presentation and surgical intervention, specific microorganism isolated by cultures and susceptibility according to the antibiogram
Summary
Endophthalmitis is one of the most dreadful entities in Ophthalmology. Whether of exogenous or endogenous origin, the consequences for the visual function and globe integrity could be poor. The majority of cases are related to intraocular surgery Exogenous cases especially those related to trauma and endogenous cases pose a challenge for the ophthalmologist who needs to institute prompt and effective treatment in order to obtain the best possible results [1,2,3]. Characterizing the epidemiological data is important in order to reveal the spectrum of the most common pathogens, their susceptibility/resistance profile, the predisposing conditions and to determine the best empirical antibiotic regimen to use. This data will lead to the establishment of the most appropriate management strategies. The aim of the present study is to analyze the epidemiological, clinical, microbial spectra and antibiotic susceptibility of patients diagnosed with endophthalmitis in a tertiary referral center in Jerusalem
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