Abstract
BackgroundAcute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss. A 10-year study of APE was conducted to determine its incidence, microbiological spectra and antibiotic resistance profile of APE-related pathogens at a major tertiary referral center in Brazil.MethodsAPE cases reported between January 2010 and December 2019 were included. Phacoemulsification and extracapsular cataract techniques were eligible; combined procedures, traumatic and congenital cataract were excluded. Vitreous samples were cultured and antimicrobial resistance was compared for the periods of 2010–2014 and 2015–2019. The results were analyzed with Fisher’s exact test.ResultsOur sample consisted of 40,491 cataract surgeries and 51 (0.126%) APE cases. Culture was positive in 35 cases (71.4%), of which 31 (88.6%) Gram-positive, 3 (8.6%) Gram-negative, and 1 (2.9%) fungal. The most frequently isolated organism was Staphylococcus epidermidis (n = 17/35, 48.6%), followed by Staphylococcus aureus (n = 4/35, 11.4%). From 2010–2014 to 2015–2019, antimicrobial resistance increased against moxifloxacin (11.1–54.5%, p = 0.07), ciprofloxacin (54.5–72.7%, p = 0.659) and oxacillin (66.7–93.3%, p = 0.13).ConclusionsThe observed incidence and microbial spectra were compatible with previous studies. A trend towards growing moxifloxacin and ciprofloxacin resistance was observed. Surveillance remains crucial to prevent treatment failure from antimicrobial resistance.
Highlights
Acute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss
APE prevention and management depend on empirical antibiotic therapy
Comparing the two periods (2010–2014 vs. 2015–2019), an increase was observed for ciprofloxacin, moxifloxacin, oxacillin, and gentamicin. None of these differences reached statistical significance (Fig. 1). In this 10-year study (2010–2019) conducted at a tertiary referral center within the Brazilian public health care system, we determined the rate of APE based on a sample of 40,491 cataract surgeries
Summary
Acute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss. A 10-year study of APE was conducted to determine its incidence, microbiological spectra and antibiotic resistance profile of APE-related pathogens at a major tertiary referral center in Brazil. According to the World Health Organization, cataract is the leading cause of reversible blindness, affecting about 20 million Americans in 2010 and possibly as many as 50 million by 2050 [1]. APE prevention and management depend on empirical antibiotic therapy. Even when referral and treatment are timely, outcomes remain generally poor. Less than half of the patients achieve final visual acuity of 20/40 after treatment [8, 9]. Visual prognosis depends on acuity at presentation, comorbidities, etiological agent and antibiotic resistance
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