Abstract
PurposeTo analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients.MethodsPatients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively.ResultsA total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0–3 years, 16.3% in 4–12 years, and 6.3% in 13–17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%.ConclusionTrauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.
Highlights
Pediatric endophthalmitis is a rare but devastating condition, resulting in visual impairment and even blindness
Recent reports on pediatric endophthalmitis mostly focused on endophthalmitis due to a specific etiology such as pediatric cataract surgery [8], trauma [3, 9], and endogenous infection [6] or focused on a specific type of endophthalmitis caused by a certain pathogen [10]
Twelve (9.4%) patients were diagnosed as having endogenous endophthalmitis; four (33.3%) of them had potential systemic risk factors for endophthalmitis: one with prior upper respiratory tract infection and fever; one with acute sinusitis; one had recurrent pneumonia and arthritis before onset; and one received systemic steroid therapy
Summary
Pediatric endophthalmitis is a rare but devastating condition, resulting in visual impairment and even blindness. Zhang and colleagues reported the etiology and microorganism spectrum of 271 pediatric endophthalmitis cases in eastern China, of which 147 cases were culture positive; yet antibiotic susceptibility was not provided [14]. Information on antibiotic susceptibilities of endophthalmitis in children is critical for guiding empiric antibiotic treatment. Data on microbiologic isolates and antibiotic susceptibility, as well as changing trends in pediatric endophthalmitis, could help guide empiric antibiotic treatment but are currently limited. We reviewed a comparatively large sample of 127 inpatient, culture-proven cases of pediatric endophthalmitis, with the following aims: (1) to describe the distribution of etiology, microbiological isolates, and antibiotic susceptibilities in pediatric patients with endophthalmitis and (2) to identify the changing trends in microbiological profile in pediatric endophthalmitis. Our findings provide information to ophthalmologists for the empiric treatment of pediatric endophthalmitis
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