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

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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
Pages (from-to)1-5
Number of pages5
JournalJournal of Ophthalmic Inflammation and Infection
Volume3
Issue number1
DOIs
StatePublished - Dec 1 2013

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Endophthalmitis
Ceftazidime
Amikacin
Visual Acuity
Imipenem
Fluoroquinolones
Confidence Intervals
Pseudomonas
India
Haemophilus
Enterobacter
Gram-Negative Bacteria
Tertiary Care Centers
Medical Records
Anti-Bacterial Agents
Bacteria
Light

Keywords

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

ASJC Scopus subject areas

  • Ophthalmology
  • Infectious Diseases

Cite this

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis : Prevalence, antimicrobial susceptibilities, and visual acuity outcome. / Jindal, Animesh; Pathengay, Avinash; Khera, Manav; Jalali, Subhadra; Mathai, Annie; Pappuru, Rajeev Reddy; Narayanan, Raja; Sharma, Savitri; Das, Taraprasad; Flynn, Harry W.

In: Journal of Ophthalmic Inflammation and Infection, Vol. 3, No. 1, 01.12.2013, p. 1-5.

Research output: Contribution to journalArticle

Jindal, Animesh ; Pathengay, Avinash ; Khera, Manav ; Jalali, Subhadra ; Mathai, Annie ; Pappuru, Rajeev Reddy ; Narayanan, Raja ; Sharma, Savitri ; Das, Taraprasad ; Flynn, Harry W. / Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis : Prevalence, antimicrobial susceptibilities, and visual acuity outcome. In: Journal of Ophthalmic Inflammation and Infection. 2013 ; Vol. 3, No. 1. pp. 1-5.
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abstract = "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.",
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T2 - Prevalence, antimicrobial susceptibilities, and visual acuity outcome

AU - Jindal, Animesh

AU - Pathengay, Avinash

AU - Khera, Manav

AU - Jalali, Subhadra

AU - Mathai, Annie

AU - Pappuru, Rajeev Reddy

AU - Narayanan, Raja

AU - Sharma, Savitri

AU - Das, Taraprasad

AU - Flynn, Harry W

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N2 - 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.

AB - 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.

KW - Amikacin

KW - Antibiotic resistance

KW - Antibiotics

KW - Ceftazidime

KW - Endophthalmitis

KW - Gram-negative organisms

KW - Vitrectomy

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