Advertisement

Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis: a 10-year retrospective study

  • Eun Young Choi
  • Jae Yong Han
  • Hyukmin Lee
  • Sung Chul Lee
  • Hyoung Jun Koh
  • Sung Soo Kim
  • Min KimEmail author
Inflammatory Disorders

Abstract

Purpose

Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE.

Methods

The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors.

Results

Among 171 eyes, 121 (70.8%) eyes developed IE after intraocular surgery (cataract surgery, 46.3%; intraocular injection, 13.2%), 37 (21.6%) eyes developed IE endogenously, and 9 (5.3%) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4%) and Klebsiella pneumoniae (7.0%). In total, 72.6% of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P = .027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P = .003).

Conclusion

Antibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.

Keywords

Infectious endophthalmitis Intraocular antibiotic injection Early vitrectomy Antibiotic resistance Prognostic factor 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures conducted in the study involving human participants were in accordance with the ethical standards of the Institutional Research Committee (Institutional Review Board at Gangnam Severance Hospital, Seoul, Republic of Korea), as well as with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent not was required.

References

  1. 1.
    Endophthalmitis Vitrectomy Study Group (1995) Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis vitrectomy study group. Arch Ophthalmol 113(12):1479–1496Google Scholar
  2. 2.
    Sheu SJ (2017) Endophthalmitis. Korean J Ophthalmol 31:283–289CrossRefGoogle Scholar
  3. 3.
    Kriechbaum K, Michels S, Prager F, Georgopoulos M, Funk M, Geitzenauer W, Schmidt-Erfurth U (2008) Intravitreal Avastin for macular oedema secondary to retinal vein occlusion: a prospective study. Br J Ophthalmol 92:518–522CrossRefGoogle Scholar
  4. 4.
    Mezad-Koursh D, Goldstein M, Heilwail G, Zayit-Soudry S, Loewenstein A, Barak A (2010) Clinical characteristics of endophthalmitis after an injection of intravitreal antivascular endothelial growth factor. Retina 30:1051–1057CrossRefGoogle Scholar
  5. 5.
    Chee SP, Jap A (2001) Endogenous endophthalmitis. Curr Opin Ophthalmol 12:464–470CrossRefGoogle Scholar
  6. 6.
    Lim HW, Shin JW, Cho HY, Kim HK, Kang SW, Song SJ, Yu HG, Oh JR, Kim JS, Moon SW, Chae JB, Park TK, Song Y (2014) Endogenous endophthalmitis in the Korean population: a six-year retrospective study. Retina 34:592–602CrossRefGoogle Scholar
  7. 7.
    Chiquet C, Cornut PL, Benito Y, Thuret G, Maurin M, Lafontaine PO, Pechinot A, Palombi K, Lina G, Bron A, Denis P, Carricajo A, Creuzot C, Romanet JP, Vandenesch F, French Institutional Endophthalmitis Study G (2008) Eubacterial PCR for bacterial detection and identification in 100 acute postcataract surgery endophthalmitis. Invest Ophthalmol Vis Sci 49:1971–1978CrossRefGoogle Scholar
  8. 8.
    Cornut PL, Thuret G, Creuzot-Garcher C, Maurin M, Pechinot A, Bron A, Gain P, Carricajo A, Denis P, Romanet JP, Vandenesch F, Chiquet C, French Institutional Endophthalmitis Study G (2012) Relationship between baseline clinical data and microbiologic spectrum in 100 patients with acute postcataract endophthalmitis. Retina 32:549–557CrossRefGoogle Scholar
  9. 9.
    Combey de Lambert A, Campolmi N, Cornut PL, Aptel F, Creuzot-Garcher C, Chiquet C, French Institutional Endophthalmitis Study G (2013) Baseline factors predictive of visual prognosis in acute postoperative bacterial endophthalmitis in patients undergoing cataract surgery. JAMA Ophthalmol 131:1159–1166CrossRefGoogle Scholar
  10. 10.
    Chiquet C, Maurin M, Altayrac J, Aptel F, Boisset S, Vandenesch F, Cornut PL, Romanet JP, Gain P, Carricajo A (2015) Correlation between clinical data and antibiotic resistance in coagulase-negative Staphylococcus species isolated from 68 patients with acute post-cataract endophthalmitis. Clin Microbiol Infect 21(592):e591–e598Google Scholar
  11. 11.
    Gentile RC, Shukla S, Shah M, Ritterband DC, Engelbert M, Davis A, Hu DN (2014) Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review. Ophthalmology 121:1634–1642CrossRefGoogle Scholar
  12. 12.
    Holland EJ, McDonald MB, Parekh JG, Sheppard JD (2014) Antibiotic resistance in acute postoperative endophthalmitis. Ophthalmology 121:S1–S9 quiz S10–12CrossRefGoogle Scholar
  13. 13.
    Ding Y, Lin M, Liu H, Zhang W, Wang L, Li Y (2011) Outcomes of post-cataract surgery endophthalmitis referred to a tertiary center from local hospitals in the south of China. Infection 39:451–460CrossRefGoogle Scholar
  14. 14.
    Seong Chan Choi M, Han Joo Cho MD, Hyoung Seok Kim MD, Jung Il Han MD, Dong Won Lee MD, Sung Won Cho MD, Tae Gon Lee MD, Chul Gu Kim MD, Jong Woo Kim MD (2016) Analysis of referred 113 patients with endophthalmitis after cataract surgery and associated prognostic factors. J Korean Ophthalmol Soc 57:420–428CrossRefGoogle Scholar
  15. 15.
    Lee S, Um T, Joe SG, Hwang JU, Kim JG, Yoon YH, Lee JY (2012) Changes in the clinical features and prognostic factors of endogenous endophthalmitis: fifteen years of clinical experience in Korea. Retina 32:977–984CrossRefGoogle Scholar
  16. 16.
    Ma WJ, Zhang H, Zhao SZ (2011) Laboratory diagnosis of infectious endophthalmitis. Int J Ophthalmol 4:100–102Google Scholar
  17. 17.
    Institute CaLS (2014) Performance standards for antimicrobial susceptibility testing. Twenty fourth Informational supplement, M100-S24. Clinical and Laboratory Standards Institute, Wayne, PAGoogle Scholar
  18. 18.
    Katz MH (2006) Multivariable analysis : a practical guide for clinicians, 2nd edn. Cambridge University Press, Cambridge ; New YorkCrossRefGoogle Scholar
  19. 19.
    Johnson RA, Wichern DW (2019) Applied multivariate statistical analysis, sixth edition Pearson modern classic edition . Edn. Pearson, Upper Saddle River, New JerseyGoogle Scholar
  20. 20.
    Slean GR, Shorstein NH, Liu L, Paschal JF, Winthrop KL, Herrinton LJ (2017) Pathogens and antibiotic sensitivities in endophthalmitis. Clin Exp Ophthalmol 45:481–488CrossRefGoogle Scholar
  21. 21.
    Huz JI, Mukkamala K, Pagan IR, Ritterband D, Shah M, Gentile RC, Engelbert M (2017) Clinical outcomes and antibiotic susceptibilities of Staphylococcus aureus endophthalmitis. Graefes Arch Clin Exp Ophthalmol 255:651–656CrossRefGoogle Scholar
  22. 22.
    Miller DM, Vedula AS, Flynn HW Jr, Miller D, Scott IU, Smiddy WE, Murray TG, Venkatraman AS (2007) Endophthalmitis caused by staphylococcus epidermidis: in vitro antibiotic susceptibilities and clinical outcomes. Ophthalmic Surg Lasers Imaging 38:446–451Google Scholar
  23. 23.
    Endophthalmitis Vitrectomy Study Group (1996) Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol 122(6):830–846Google Scholar
  24. 24.
    Kurniawan ED, Rocke JR, Sandhu SS, Allen PJ (2017) Predictors of visual outcome and the role of early vitrectomy in streptococcal endophthalmitis. Clin Exp Ophthalmol.  https://doi.org/10.1111/ceo.13077
  25. 25.
    Callegan MC, Booth MC, Jett BD, Gilmore MS (1999) Pathogenesis of gram-positive bacterial endophthalmitis. Infect Immun 67:3348–3356Google Scholar
  26. 26.
    Mishra D, Satpathy G, Chawla R, Venkatesh P, Ahmed NH, Panda SK (2018) Utility of broad-range 16S rRNA PCR assay versus conventional methods for laboratory diagnosis of bacterial endophthalmitis in a tertiary care hospital. Br J Ophthalmol.  https://doi.org/10.1136/bjophthalmol-2018-312877
  27. 27.
    Pongsachareonnont P, Honglertnapakul W, Chatsuwan T (2017) Comparison of methods for identifying causative bacterial microorganisms in presumed acute endophthalmitis: conventional culture, blood culture, and PCR. BMC Infect Dis 17:165CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Ophthalmology, Gangnam Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Laboratory Medicine and Research Institute of Bacterial ResistanceYonsei University College of MedicineSeoulSouth Korea
  3. 3.Department of Ophthalmology, Severance HospitalYonsei University College of MedicineSeoulSouth Korea

Personalised recommendations