Clinical Features, Antibiotic Susceptibilities, and Treatment Outcomes of Endophthalmitis Caused by Staphylococcus epidermidis.

Abstract

PURPOSE:

To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive Staphylococcus epidermidis and methicillin-resistant S. epidermidis.

DESIGN:

Retrospective case series.

PARTICIPANTS:

All patients seeking treatment at a tertiary referral center between 2006 and 2016 with endophthalmitis caused by S. epidermidis.

METHODS:

All records were reviewed for patients with a clinical diagnosis of endophthalmitis and positive vitreous culture results for S. epidermidis. Data were compared with the prior series at the same institution.

MAIN OUTCOME MEASURES:

Clinical settings, antibiotic susceptibilities, and visual acuity.

RESULTS:

Among 96 eyes of 96 patients, the most common postprocedural clinical settings were cataract surgery (47/96 [49%]), intravitreal injection (21/96 [22%]), trauma (8/96 [8%]), glaucoma surgery (7/96 [7%]), and penetrating keratoplasty (5/96 [5%]). The initial treatment included intravitreal vancomycin and ceftazidime in 89 of 96 eyes (93%) and intravitreal vancomycin and amikacin in 7 of 96 eyes (7%). A vitreous tap and injection with antibiotics was performed as the initial treatment in 83 of 96 eyes (86%) and pars plana vitrectomy was performed in 13 of 96 eyes (14%). All isolates were sensitive to vancomycin in both decades. In the most recent series, visual acuity at last follow-up was 5/200 or better in 68 of 96 eyes (71%) compared with 71 of 86 eyes (83%) in the prior study. In the current study, susceptibility to methicillin and moxifloxacin was present in 45 of 96 eyes (47%) and 29 of 85 eyes (34%), respectively, compared with 34 of 86 eyes (40%) and 27 of 39 eyes (69%) in the prior study. Final visual acuity was not significantly different between those eyes that were methicillin or fluoroquinolone sensitive and those that were resistant.

CONCLUSIONS:

In the current and prior series, all S. epidermidis isolates were sensitive to vancomycin. Visual acuity outcomes were not dependent on methicillin or fluoroquinolone sensitivity.

• Authors: Nicolas A Yannuzzi, Nimesh A Patel, Nidhi Relhan, Kimberly D Tran, Nancy Si, Thomas A Albini, Audina M Berrocal, Janet L Davis, William E Smiddy, Justin Townsend, Darlene Miller, Harry W Flynn Jr
• Journal: Ophthalmology. Retina (Ophthalmol Retina) Vol. 2 Issue 5 Pg. 396-400 (05 2018) ISSN: 2468-6530 [Electronic] United States
• PMID: 31047321 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.