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Objective To analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.Methods A total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study.Among them,410 patients with 410 eyes were males (77.2％),121 patients with 121 eyes were females (22.8％).The average age of the patients was 38.62± 15.36 years.The relevant medical records were collected to analyze the pathogenic factors.Samples of aqueous humor,vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.Results Ocular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1％),other factors included postoperative endophthalmitis (19.0％),suppurative keratitis-related endophthalmitis (17.1％) and endogenous endophthalmitis (3.8％).Postoperative endophthalmitis mainly occured after cataract surgery.A total of 224 strains of organisms were isolated,among which the predominant organisms isolated were gram-positive bacteria (54.0％) and staphylococcus epidermidis was the most common (25.0％).The other pathogenic organisms were fungi (29.5％) and gram-negative bacteria (16.5％).Among the fungi,aspergillus (10.7％) was the dominant genus,followed by fusarium (9.8％).For gram-positive organisms,susceptibilities were vancomycin 97.4％,gatifloxacin 91.8％,fusidate acid 77.9％ and levofloxacin 54.6％.For gram-negative organisms,susceptibilities were gatifloxacin 85.7％,levofloxacin 77.8％,tobramycin 71.4％ and ceftazidime 62.5％.For fungal isolates,sensitivities were voriconazole 88.2％ and amphotericin B 84.8％.Conclusions Ocular trauma is the main pathogenic factor of suppurative endophthalmitis,followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis.Gram-positive bacteria are the major pathogenic organisms,especially staphylococcus epidermidis followed by fungal species,among which aspergillus and fusarium were the dominating pathogenic genus.
ABSTRACT
Background. Endophtalmitis post cataract surgery is one of most feared and devastating complications resulting in serious consequences and an uncertain visual prognosis. Antimicrobial prophylaxis against endophtalmitis must be based on the best knowledge of conjuntival microbiota. Objective: To establish microbiological basis for the best antibiotic prophylaxis to prevent endophthalmitis in cataract surgery. Materials and Methods: A descriptive, cross-sectional, prospective study. A preoperative conjunctival sample was taken from the lower fornix of 118 pacients, sowing it immediately in culture media. Identification of growing colonies and susceptibility testing were performed by manual or automated methods. Results: 106 (89.8%) of 118 preoperative cultures were positive. 159 bacteria were isolated in single or mixed flora, with 95% of Gram positive organisms. Staphylococci represented 76.1% of isolated bacteria, with 82.6% of coagulase-negative staphylococci (SCN) and 17.4% of Staphylococcus aureus. Forty two percent of SCN and 38% of S. aureus were methicillin resistan; both groups showed high susceptibility to tobramycin and fourth-generation fluoroquinolones. Conclusions: we recommend the use of topical tobramycin as pre-operative antimicrobial prophylaxis associated with povidone-iodine antisepsis. A fourth-generation quinolone is recommended when there is risk of infection.
Introducción: La endoftalmitis post-cirugía de cataratas es una de las complicaciones post-operatorias más temidas y devastadoras, pudiendo ocasionar secuelas graves, con un pronóstico visual incierto. La profilaxis antimicrobiana de esta complicación debe basarse en el conocimiento acabado de la microbiota presente en el territorio conjuntival. Objetivo: Establecer bases microbiológicas para una mejor profilaxis antimicrobiana de la endoftalmitis en cirugía de cataratas. Materiales y Métodos: Estudio descriptivo, de corte transversal, prospectivo. A 118 pacientes se les tomó muestra conjuntival pre-operatoria del fondo de saco inferior, sembrándola de inmediato en medios de cultivo. Las colonias desarrolladas se identificaron por métodos manuales y método de microdilución y difusión en disco. Resultados: De 118 cultivos pre-operatorios, 106 (89,8%) desarrollaron colonias bacterianas. Se aislaron 159 bacterias conjuntivales como especie única o cultivo mixta, siendo 95% grampositivas. El género Staphylococcus representó 76,1% del total de bacterias aisladas, siendo 82,6% Staphylococcus coagulasa negativa (SCN) y 17,4% Staphylococcus aureus. El 42% de los SCN y 38% de S. aureus presentaron resistencia a meticilina, presentando ambos buena susceptibilidad a tobramicina y fluoroquinolonas de cuarta generación. Conclusiones: Considerando nuestros resultados, recomendaríamos a nuestros pacientes tobramicina tópica como antibioprofilaxis, asociada a povidona yodada como antiséptico. Una quinolona de cuarta generación podría usarse cuando existan factores de riesgo de infección.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cataract Extraction , Conjunctiva/microbiology , Endophthalmitis/prevention & control , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Antibiotic Prophylaxis , Anti-Bacterial Agents/pharmacology , Cross-Sectional Studies , Disk Diffusion Antimicrobial Tests , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Prospective StudiesABSTRACT
Objective To analyze the causes and pathogens of infectious endophthalmitis in ourhospital.Methods The clinical data and laboratory findings of 282 inpatients with infectiousendophthalmitis were retrospectively reviewed.There were 206 males(73.05%)and 76 females(26.95%)with a mean age of(36.0±11.2)years(range from 2 to 79 years).Except 14 patients who lost theireyeballs as of serious conditions.pathogen examinations of vitreous specimen had been performed for allremaining 268 cases.The clinieal and laboratory data were statistically analyzed by Chi-square and Kappaconsistency tests,when P<0.05 the difference should be considered as statistically significant.ResultsThe 4 major causes of infectious endophthalmitis of those 282 patients included ocular trauma(177cases,62.77%),infectious keratitis(61 cases,21.63%),eye surgery(32 cases,11.35%),andendogenous endophthalmitis(12 cases,4.25%).19.21% of the patients in ocular trauma group was 2-13years old,55.74% of the patients in infectious keratitis group was 14-50 years old,and 60.61% of thepatients in eye surgery group was 51-79 years old.The major pathogens were fungus and staphylococcieach accounted for 30.63% of all cases.Most of the pathogenic bacteria were sensitive to ciprofloxaein(81.81%)and gentamicin(77.92%).Conclusions The major reason of infectious endophthalmitis wasocular trauma,and the major pathogens were fungus and staphylococci.Those findings may help us totreat infectious endophthalmitis patients appropriately.