Endophthalmitis caused by enterococcus faecalis: Clinical features, antibiotic sensitivities, and outcomes

Ajay Kuriyan, Jayanth Sridhar, Harry W Flynn, William E Smiddy, Thomas A Albini, Audina Berrocal, Richard Forster, Peter J. Belin, Darlene Miller

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To report the clinical features, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis.

Study Design: Retrospective, observational case series.

Methods: A consecutive case series of patients with culture-positive endophthalmitis caused by E. faecalis between January 1, 2002, and December 31, 2012, at an academic referral center.

Results: Of 14 patients identified, clinical settings included bleb association (n = 8), occurrence after cataract surgery (n = 4), and occurrence after penetrating keratoplasty (n = 2). All isolates were vancomycin sensitive. When comparing isolates in the current study with isolates from 1990 through 2001, the minimal inhibitory concentration required to inhibit 90% of isolates increased for ciprofloxacin (4 μg/mL from 1 μg/mL), erythromycin (256 μg/mL from 4 μg/mL), and penicillin (8 μg/mL from 4 μg/mL), indicating higher levels of resistance. The minimal inhibitory concentration required to inhibit 90% of isolates remained the same for vancomycin (2 μg/mL) and linezolid (2 μg/mL). Presenting visual acuity ranged from hand movements to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 12) and pars plana vitrectomy with intravitreal antibiotic injection (n[2). Visual acuity outcomes were 20/400 or worse in 13 (93%) of 14 patients.

Conclusion: Although all isolates were sensitive to vancomycin and linezolid, higher minimal inhibitory concentration required to inhibit 90% of isolates in the current study, compared with isolates from 1990 through 2001, occurred with ciprofloxacin, erythromycin, and penicillin. Despite prompt treatment, most patients had poor outcomes.

Original languageEnglish
Pages (from-to)1018-1023
Number of pages6
JournalAmerican Journal of Ophthalmology
Volume158
Issue number5
DOIs
StatePublished - Jan 1 2014

Fingerprint

Linezolid
Endophthalmitis
Enterococcus faecalis
Vancomycin
Anti-Bacterial Agents
Visual Acuity
Intravitreal Injections
Erythromycin
Ciprofloxacin
Penicillins
Penetrating Keratoplasty
Temazepam
Vitrectomy
Blister
Cataract
Referral and Consultation
Retrospective Studies
Hand
Light
Therapeutics

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Endophthalmitis caused by enterococcus faecalis : Clinical features, antibiotic sensitivities, and outcomes. / Kuriyan, Ajay; Sridhar, Jayanth; Flynn, Harry W; Smiddy, William E; Albini, Thomas A; Berrocal, Audina; Forster, Richard; Belin, Peter J.; Miller, Darlene.

In: American Journal of Ophthalmology, Vol. 158, No. 5, 01.01.2014, p. 1018-1023.

Research output: Contribution to journalArticle

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abstract = "Purpose: To report the clinical features, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis.Study Design: Retrospective, observational case series.Methods: A consecutive case series of patients with culture-positive endophthalmitis caused by E. faecalis between January 1, 2002, and December 31, 2012, at an academic referral center.Results: Of 14 patients identified, clinical settings included bleb association (n = 8), occurrence after cataract surgery (n = 4), and occurrence after penetrating keratoplasty (n = 2). All isolates were vancomycin sensitive. When comparing isolates in the current study with isolates from 1990 through 2001, the minimal inhibitory concentration required to inhibit 90{\%} of isolates increased for ciprofloxacin (4 μg/mL from 1 μg/mL), erythromycin (256 μg/mL from 4 μg/mL), and penicillin (8 μg/mL from 4 μg/mL), indicating higher levels of resistance. The minimal inhibitory concentration required to inhibit 90{\%} of isolates remained the same for vancomycin (2 μg/mL) and linezolid (2 μg/mL). Presenting visual acuity ranged from hand movements to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 12) and pars plana vitrectomy with intravitreal antibiotic injection (n[2). Visual acuity outcomes were 20/400 or worse in 13 (93{\%}) of 14 patients.Conclusion: Although all isolates were sensitive to vancomycin and linezolid, higher minimal inhibitory concentration required to inhibit 90{\%} of isolates in the current study, compared with isolates from 1990 through 2001, occurred with ciprofloxacin, erythromycin, and penicillin. Despite prompt treatment, most patients had poor outcomes.",
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