Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment

Nidhi Relhan, Thomas A Albini, Avinash Pathengay, Ajay Kuriyan, Darlene Miller, Harry W Flynn

Research output: Contribution to journalReview article

22 Scopus citations

Abstract

BACKGROUND: Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or resistance is an important clinical issue worldwide.

PURPOSE: To review the published literature on endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance.

METHODS: The data were analysed from a PubMed search of endophthalmitis cases caused by Gram-positive organisms with reported reduced vancomycin susceptibility and/or vancomycin resistance from 1990 to 2015.

RESULTS: From 18 publications identified, a total of 27 endophthalmitis cases caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance were identified. The aetiologies of endophthalmitis were exogenous in 19/27 cases (11 post-cataract surgery, 2 post-penetrating keratoplasty, 1 post-glaucoma surgery, 4 post-open globe injury, 1 post-intravitreal injection of ranibizumab), and endogenous in 4/24 cases; no details were available about the four remaining patients. The causative organisms included Enterococcus species (7/27), coagulase-negative staphylococci (4/27), Staphylococcus aureus (4/27), Bacillus species (4/27), Streptococcus species (3/27), Leuconostoc species (3/27), Staphylococcus hominis (1/27), and unidentified Gram-positive cocci (1/27). Visual acuity of 20/400 or better at the final follow-up was recorded in 10/26 patients (38.5%; data were not available for one patient). Treatment options include fluoroquinolones, penicillin, cephalosporins, tetracyclines, and oxazolidinones.

CONCLUSIONS: In the current study, visual acuity outcomes were generally poor. Enterococcus and Staphylococcus species were the most common organisms reported and postoperative endophthalmitis after cataract surgery was the most common clinical setting.

Original languageEnglish (US)
Pages (from-to)446-452
Number of pages7
JournalThe British journal of ophthalmology
Volume100
Issue number4
DOIs
StatePublished - Apr 1 2016

Keywords

  • Eye (Globe)
  • Infection
  • Microbiology
  • Retina
  • Vitreous

ASJC Scopus subject areas

  • Medicine(all)
  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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