Endophthalmitis isolates and antibiotic susceptibilities: A 10-year review of culture-proven cases

Andrew M. Schimel, Darlene Miller, Harry W Flynn

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Abstract

Purpose: To investigate the spectrum of organisms causing culture-proven endophthalmitis and their susceptibilities to commonly used antimicrobial agents over 10 years. Design: Retrospective, noncomparative, consecutive case series. Methods: Medical records were reviewed of all cases with culture-proven endophthalmitis at a single institution from 2002 through 2011. The outcome measures included all intravitreal isolates identified as well as antibiotic susceptibilities. Results: A total of 448 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 30.1% (135/448), Streptococcus viridians group in 10.9% (49/448), Staphylococcus aureus in 7.8% (35/448), Candida albicans in 5.8% (26/443), other coagulase-negative staphylococci in 6.0% (27/448), Propionibacterium acnes in 4.7% (21/448), and Pseudomonas aeruginosa in 3.1% (14/448). Overall, 327 (72.9%) of 448 isolates were gram-positive organisms, 48 (10.7%) of 448 isolates were gram-negative organisms, 71 (15.8%) of 448 isolates were fungi, and 2 (0.4%) of 448 isolates were viruses. For gram-positive organisms, susceptibilities were the following: vancomycin, 100%; gentamicin, 88.0%; sulfamethoxazole/trimethoprim, 77.5%; levofloxacin, 58.5%; oxacillin, 54.7%; ciprofloxacin, 51.0%; gatifloxacin, 51.0%; and moxifloxacin, 47.0%. For gram-negative organisms, susceptibilities were the following: ceftazidime, 100%; levofloxacin, 100%; ciprofloxacin, 95.0%; tobramycin, 90.6%; gentamicin, 80.6%; and sulfamethoxazole/trimethoprim, 59.4%. Conclusions: In the current study, no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy generally is the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may guide the use of initial antifungal agents.

Original languageEnglish
JournalAmerican Journal of Ophthalmology
Volume156
Issue number1
DOIs
StatePublished - Jul 1 2013

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Endophthalmitis
antineoplaston A10
Anti-Bacterial Agents
Levofloxacin
Sulfamethoxazole Drug Combination Trimethoprim
Ciprofloxacin
Gentamicins
Oxacillin
Propionibacterium acnes
Tobramycin
Ceftazidime
Staphylococcus epidermidis
Antifungal Agents
Coagulase
Vancomycin
Anti-Infective Agents
Streptococcus
Candida albicans
Staphylococcus
Pseudomonas aeruginosa

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{0b9dc4a015374247bc3761fc3ed3ea72,
title = "Endophthalmitis isolates and antibiotic susceptibilities: A 10-year review of culture-proven cases",
abstract = "Purpose: To investigate the spectrum of organisms causing culture-proven endophthalmitis and their susceptibilities to commonly used antimicrobial agents over 10 years. Design: Retrospective, noncomparative, consecutive case series. Methods: Medical records were reviewed of all cases with culture-proven endophthalmitis at a single institution from 2002 through 2011. The outcome measures included all intravitreal isolates identified as well as antibiotic susceptibilities. Results: A total of 448 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 30.1{\%} (135/448), Streptococcus viridians group in 10.9{\%} (49/448), Staphylococcus aureus in 7.8{\%} (35/448), Candida albicans in 5.8{\%} (26/443), other coagulase-negative staphylococci in 6.0{\%} (27/448), Propionibacterium acnes in 4.7{\%} (21/448), and Pseudomonas aeruginosa in 3.1{\%} (14/448). Overall, 327 (72.9{\%}) of 448 isolates were gram-positive organisms, 48 (10.7{\%}) of 448 isolates were gram-negative organisms, 71 (15.8{\%}) of 448 isolates were fungi, and 2 (0.4{\%}) of 448 isolates were viruses. For gram-positive organisms, susceptibilities were the following: vancomycin, 100{\%}; gentamicin, 88.0{\%}; sulfamethoxazole/trimethoprim, 77.5{\%}; levofloxacin, 58.5{\%}; oxacillin, 54.7{\%}; ciprofloxacin, 51.0{\%}; gatifloxacin, 51.0{\%}; and moxifloxacin, 47.0{\%}. For gram-negative organisms, susceptibilities were the following: ceftazidime, 100{\%}; levofloxacin, 100{\%}; ciprofloxacin, 95.0{\%}; tobramycin, 90.6{\%}; gentamicin, 80.6{\%}; and sulfamethoxazole/trimethoprim, 59.4{\%}. Conclusions: In the current study, no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy generally is the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may guide the use of initial antifungal agents.",
author = "Schimel, {Andrew M.} and Darlene Miller and Flynn, {Harry W}",
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AU - Schimel, Andrew M.

AU - Miller, Darlene

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N2 - Purpose: To investigate the spectrum of organisms causing culture-proven endophthalmitis and their susceptibilities to commonly used antimicrobial agents over 10 years. Design: Retrospective, noncomparative, consecutive case series. Methods: Medical records were reviewed of all cases with culture-proven endophthalmitis at a single institution from 2002 through 2011. The outcome measures included all intravitreal isolates identified as well as antibiotic susceptibilities. Results: A total of 448 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 30.1% (135/448), Streptococcus viridians group in 10.9% (49/448), Staphylococcus aureus in 7.8% (35/448), Candida albicans in 5.8% (26/443), other coagulase-negative staphylococci in 6.0% (27/448), Propionibacterium acnes in 4.7% (21/448), and Pseudomonas aeruginosa in 3.1% (14/448). Overall, 327 (72.9%) of 448 isolates were gram-positive organisms, 48 (10.7%) of 448 isolates were gram-negative organisms, 71 (15.8%) of 448 isolates were fungi, and 2 (0.4%) of 448 isolates were viruses. For gram-positive organisms, susceptibilities were the following: vancomycin, 100%; gentamicin, 88.0%; sulfamethoxazole/trimethoprim, 77.5%; levofloxacin, 58.5%; oxacillin, 54.7%; ciprofloxacin, 51.0%; gatifloxacin, 51.0%; and moxifloxacin, 47.0%. For gram-negative organisms, susceptibilities were the following: ceftazidime, 100%; levofloxacin, 100%; ciprofloxacin, 95.0%; tobramycin, 90.6%; gentamicin, 80.6%; and sulfamethoxazole/trimethoprim, 59.4%. Conclusions: In the current study, no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy generally is the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may guide the use of initial antifungal agents.

AB - Purpose: To investigate the spectrum of organisms causing culture-proven endophthalmitis and their susceptibilities to commonly used antimicrobial agents over 10 years. Design: Retrospective, noncomparative, consecutive case series. Methods: Medical records were reviewed of all cases with culture-proven endophthalmitis at a single institution from 2002 through 2011. The outcome measures included all intravitreal isolates identified as well as antibiotic susceptibilities. Results: A total of 448 organisms were isolated during the study interval. The most common organisms identified were Staphylococcus epidermidis in 30.1% (135/448), Streptococcus viridians group in 10.9% (49/448), Staphylococcus aureus in 7.8% (35/448), Candida albicans in 5.8% (26/443), other coagulase-negative staphylococci in 6.0% (27/448), Propionibacterium acnes in 4.7% (21/448), and Pseudomonas aeruginosa in 3.1% (14/448). Overall, 327 (72.9%) of 448 isolates were gram-positive organisms, 48 (10.7%) of 448 isolates were gram-negative organisms, 71 (15.8%) of 448 isolates were fungi, and 2 (0.4%) of 448 isolates were viruses. For gram-positive organisms, susceptibilities were the following: vancomycin, 100%; gentamicin, 88.0%; sulfamethoxazole/trimethoprim, 77.5%; levofloxacin, 58.5%; oxacillin, 54.7%; ciprofloxacin, 51.0%; gatifloxacin, 51.0%; and moxifloxacin, 47.0%. For gram-negative organisms, susceptibilities were the following: ceftazidime, 100%; levofloxacin, 100%; ciprofloxacin, 95.0%; tobramycin, 90.6%; gentamicin, 80.6%; and sulfamethoxazole/trimethoprim, 59.4%. Conclusions: In the current study, no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy generally is the recommendation as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may guide the use of initial antifungal agents.

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