Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: Prevalence, antimicrobial susceptibilities, and visual acuity outcome

Animesh Jindal, Avinash Pathengay, Manav Khera, Subhadra Jalali, Annie Mathai, Rajeev Reddy Pappuru, Raja Narayanan, Savitri Sharma, Taraprasad Das, Harry W. Flynn

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14 Scopus citations


Background: The purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200. Results: Sixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients. Conclusion: In the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

Original languageEnglish (US)
Article number62
Pages (from-to)1-5
Number of pages5
JournalJournal of Ophthalmic Inflammation and Infection
Issue number1
StatePublished - Jan 1 2013



  • Amikacin
  • Antibiotic resistance
  • Antibiotics
  • Ceftazidime
  • Endophthalmitis
  • Gram-negative organisms
  • Vitrectomy

ASJC Scopus subject areas

  • Ophthalmology
  • Infectious Diseases

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