Abstract
Purpose The objective of this study was to evaluate the microbiological spectrum and antibiotic susceptibilities of isolates in posttraumatic endophthalmitis over a 15-year period. Methods A retrospective study of 3,163 posttraumatic endophthalmitis cases was conducted between July 2004 and July 2019. The outcome measures included the microbiological spectrum and antibiotic susceptibilities. Chi-squared tests were conducted to detect trends in changes in antibiotic sensitivity over the 15-year period. P values of <0.05 were considered statistically significant. Results Of the 3,163 cases of posttraumatic endophthalmitis, 1,003 culture-positive isolates were identified. Among these, there were 848 (84.5%) Gram-positive isolates, 109 (10.9%) Gram-negative isolates, and 46 (4.6%) fungal isolates. The most common isolates were Staphylococcal species. There was a significant increase in the percentage of fungal isolates over the 15-year period (P=0.02). Gram-positive organisms showed the greatest level of susceptibility to vancomycin (99.6%). The susceptibilities of the 109 Gram-negative isolated organisms were as follows: levofloxacin (95.8%), meropenem (95.7%), ciprofloxacin (93.5%), tobramycin (90.8%), imipenem (88.9%), trimethoprim-sulfamethoxazole (TMP-SMX) (87.7%), ertapenem (80%), and ceftazidime (79.1%). The susceptibility of Gram-positive organisms to several antibiotics, including levofloxacin (P=0.004), ciprofloxacin (P < 0.001), and chloramphenicol (P=0.001) decreased over time, whereas the susceptibility to TMP-SMX increased over time (P < 0.001). The susceptibility of Gram-negative bacilli to ceftazidime decreased over time (P=0.03). Conclusions Over the 15-year study period, most isolates were Gram-positive cocci, especially coagulase-negative staphylococci (CNS). Vancomycin seemed to be the most effective antibiotic for Gram-positive bacteria. Gram-negative bacteria appeared to be most susceptible to fluoroquinolones. A number of antibiotics showed an increasing trend of microbial resistance.
Highlights
Endophthalmitis is a devastating clinical condition that can lead to severe visual loss. [1,2,3,4] Previous research reported that the incidence rate of infectious endophthalmitis following intraocular foreign body (IOFB) injuries ranged from 6.9–30% [5]
Many studies have described series of posttraumatic endophthalmitis and the distribution of isolates worldwide [1, 6, 10, 11]. ese studies showed that the susceptibilities of microbiological isolates and infectious agents to particular antibiotics varied over time and differed according to regional variability, population, and ethnicity [12,13,14,15,16]. e findings of these studies point to the importance of regular periodic reviews of local susceptibilities to ensure that the most appropriate antibiotics are used to treat infections
coagulasenegative staphylococci (CNS) were involved in 56.0% of endophthalmitis cases in our study versus 23.1% in a study conducted in France [20] (Table 1)
Summary
Microbiological Isolates and Antibiotic Susceptibilities in Cases of Posttraumatic Endophthalmitis: A 15-Year Review. Received 9 September 2019; Revised 15 November 2019; Accepted 7 December 2019; Published 29 April 2020
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