Abstract
BackgroundTo assess the sensitivity, specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.MethodsRetrospective, single centre, case series study. We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st, 2000 to December 31st 2014. From each record, we documented general demographic data, best corrected visual acuity and vitreous and aqueous tap microbiological results. All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence. We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis. We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report. Significance were assessed with chi squared statistics, with an alpha value of 0.05 for statistical significance.ResultsA total of 190 cases fulfilled the inclusion/exclusion criteria. Positive culture rate from vitreous samples was 64.74%. Positive culture rate from aqueous sample was 32.11%. Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68% of the time. The overall sensitivity was 38.21%, specificity: 75.51%, positive predictive value: 79.66%, negative predictive value: 32.74% (p = 0.08). Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity (37.73%), high specificity (93%) and high positive predictive value (95%) (p < 0.04).ConclusionThe sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis. In cases of post-surgical endophthalmitis, the result of an anterior chamber tap could be used for therapeutic guidance, but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.
Highlights
To assess the sensitivity, specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence
74 cases were classified as post-surgical cases of endophthalmitis, 42 cases were classified as post-traumatic endophthalmitis, in 26 cases, the diagnosis of endophthalmitis was associated with corneal ulcers
Our results showed that the anterior chamber tap have low sensitivity and specificity in all types of endophthalmitis, except in cases of post-surgical endophthalmitis wherein the test had a moderate to low sensitivity (37.73%) and high specificity (93%)
Summary
Specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence. Clinical outcomes are closely related to several factors including aetiology, the source of contamination, virulence of the pathogen and antibiotic sensitivity, time of evolution, and treatment delays among others [1,2,3,4]. General guidelines for the treatment of bacterial infections include pathogen identification and selective antibiotic therapy, the high risk of permanent visual loss, along with the lack of a fast and reliable screening tests, a strong clinical suspicion could justify for the immediate empirical treatment with broad-spectrum intravitreal antibiotics [2, 5,6,7]. As part of the general workup and before intravitreal antibiotics, a vitreous tap is still attempted to guide therapeutic decision in the future, especially if the treatment response is suboptimal and to confirm the clinical diagnosis [6,7,8]. A sufficient but small sample may decrease the possibility of a successful bacterial growth in culture and increase the false negative rate of the test (30–40% of vitreous samples are culture negative) [9–13]
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