Polymicrobial endophthalmitis: Prevalence, causative organisms, and visual outcomes

Animesh Jindal, Mayur R. Moreker, Avinash Pathengay, Manav Khera, Subhadra Jalali, Ajit Majji, Annie Mathai, Savitri Sharma, Taraprasad Das, Harry W Flynn

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the noncomparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. Results: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200. Conclusions: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalJournal of Ophthalmic Inflammation and Infection
Volume3
Issue number1
DOIs
StatePublished - Dec 1 2013

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Endophthalmitis
Visual Acuity
Gram-Negative Bacteria
Coinfection
Fungi
Gram-Positive Cocci
Ofloxacin
Staphylococcus epidermidis
Gram-Positive Bacteria
Chloramphenicol
Vancomycin
Ciprofloxacin
Streptococcus pneumoniae
Anti-Bacterial Agents
Wounds and Injuries

Keywords

  • Antibiotic susceptibilities
  • Endophthalmitis
  • Polymicrobial

ASJC Scopus subject areas

  • Ophthalmology
  • Infectious Diseases

Cite this

Polymicrobial endophthalmitis : Prevalence, causative organisms, and visual outcomes. / Jindal, Animesh; Moreker, Mayur R.; Pathengay, Avinash; Khera, Manav; Jalali, Subhadra; Majji, Ajit; Mathai, Annie; Sharma, Savitri; Das, Taraprasad; Flynn, Harry W.

In: Journal of Ophthalmic Inflammation and Infection, Vol. 3, No. 1, 01.12.2013, p. 1-6.

Research output: Contribution to journalArticle

Jindal, A, Moreker, MR, Pathengay, A, Khera, M, Jalali, S, Majji, A, Mathai, A, Sharma, S, Das, T & Flynn, HW 2013, 'Polymicrobial endophthalmitis: Prevalence, causative organisms, and visual outcomes', Journal of Ophthalmic Inflammation and Infection, vol. 3, no. 1, pp. 1-6. https://doi.org/10.1186/1869-5760-3-6
Jindal, Animesh ; Moreker, Mayur R. ; Pathengay, Avinash ; Khera, Manav ; Jalali, Subhadra ; Majji, Ajit ; Mathai, Annie ; Sharma, Savitri ; Das, Taraprasad ; Flynn, Harry W. / Polymicrobial endophthalmitis : Prevalence, causative organisms, and visual outcomes. In: Journal of Ophthalmic Inflammation and Infection. 2013 ; Vol. 3, No. 1. pp. 1-6.
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abstract = "Background: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the noncomparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. Results: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88{\%}) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9{\%}) including Staphylococcus epidermidis (n = 14/53; 16.1{\%}) and Streptococcus pneumoniae (n = 13/53; 13.8{\%}). The etiologies included posttraumatic (n = 31/43; 72.1{\%}) and postoperative (n = 9/43; 20.9{\%}) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100{\%}) and chloramphenicol (96{\%}). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4{\%}) and ofloxacin (81.2{\%}). A maximum number of secondary interventions were done in traumatic cases (38.7{\%}) and cases having coinfection with Gram-negative bacteria and fungus (66.7{\%}). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1{\%}) as compared with postoperative cases (n = 4/9; 44.4{\%}). Of the 43 patients, only 9 patients (20.9{\%}) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3{\%}), with fungus as one of the isolates, had a VA ≥ 20/200. Conclusions: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.",
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AU - Jindal, Animesh

AU - Moreker, Mayur R.

AU - Pathengay, Avinash

AU - Khera, Manav

AU - Jalali, Subhadra

AU - Majji, Ajit

AU - Mathai, Annie

AU - Sharma, Savitri

AU - Das, Taraprasad

AU - Flynn, Harry W

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N2 - Background: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the noncomparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. Results: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200. Conclusions: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

AB - Background: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the noncomparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. Results: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200. Conclusions: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

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