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

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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.

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Authors and Affiliations

  1. Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, South Korea

    Eun Young Choi, Jae Yong Han & Min Kim

  2. Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea

    Hyukmin Lee

  3. Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    Sung Chul Lee, Hyoung Jun Koh & Sung Soo Kim

Authors
  1. Eun Young Choi
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  2. Jae Yong Han
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  3. Hyukmin Lee
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  4. Sung Chul Lee
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  5. Hyoung Jun Koh
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  6. Sung Soo Kim
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  7. Min Kim
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Correspondence to Min Kim.

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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.

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Choi, E.Y., Han, J.Y., Lee, H. et al. Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis: a 10-year retrospective study. Graefes Arch Clin Exp Ophthalmol 257, 805–813 (2019). https://doi.org/10.1007/s00417-019-04261-x

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  • DOI: https://doi.org/10.1007/s00417-019-04261-x

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