Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades
Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed...
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| Veröffentlicht in: | American journal of ophthalmology 2017-02, Vol.174, p.155-159 |
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| creator | Yannuzzi, Nicolas A., MD Si, Nancy, BS Relhan, Nidhi, MD Kuriyan, Ajay E., MD Albini, Thomas A., MD Berrocal, Audina M., MD Davis, Janet L., MD Smiddy, William E., MD Townsend, Justin, MD Miller, Darlene, CIC, DHSc Flynn, Harry W., MD |
| description | Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Results The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22/52 (42%) to levofloxacin, 20/54 (37%) to ciprofloxacin, 16/47 (34%) to moxifloxacin, and 3/13 (23%) to gatifloxacin. Conclusion Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones. |
| doi_str_mv | 10.1016/j.ajo.2016.11.006 |
| format | Article |
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Design Retrospective case series. Methods Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Results The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22/52 (42%) to levofloxacin, 20/54 (37%) to ciprofloxacin, 16/47 (34%) to moxifloxacin, and 3/13 (23%) to gatifloxacin. Conclusion Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/j.ajo.2016.11.006</identifier><identifier>PMID: 27889501</identifier><identifier>CODEN: AJOPAA</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Cataract Extraction - adverse effects ; Cataract Extraction - methods ; Cataracts ; Cornea - diagnostic imaging ; Cornea - surgery ; Endophthalmitis - diagnosis ; Endophthalmitis - drug therapy ; Endophthalmitis - etiology ; Eye Infections, Bacterial - diagnosis ; Eye Infections, Bacterial - drug therapy ; Eye Infections, Bacterial - etiology ; Eye surgery ; Female ; Follow-Up Studies ; Humans ; Laboratories ; Light ; Male ; Middle Aged ; Ophthalmology ; Organisms ; Retrospective Studies ; Sheep ; Staphylococcal Infections - diagnosis ; Staphylococcal Infections - drug therapy ; Staphylococcal Infections - etiology ; Staphylococcus - isolation & purification ; Surgical Wound Infection - diagnosis ; Surgical Wound Infection - drug therapy ; Surgical Wound Infection - etiology ; Time Factors ; Visual Acuity ; Vitreous Body - microbiology</subject><ispartof>American journal of ophthalmology, 2017-02, Vol.174, p.155-159</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 01, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-d79a93b5fa1b28293fb27290e3514b092a44551458626b1b9721f2b3de08c8893</citedby><cites>FETCH-LOGICAL-c479t-d79a93b5fa1b28293fb27290e3514b092a44551458626b1b9721f2b3de08c8893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002939416305669$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27889501$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yannuzzi, Nicolas A., MD</creatorcontrib><creatorcontrib>Si, Nancy, BS</creatorcontrib><creatorcontrib>Relhan, Nidhi, MD</creatorcontrib><creatorcontrib>Kuriyan, Ajay E., MD</creatorcontrib><creatorcontrib>Albini, Thomas A., MD</creatorcontrib><creatorcontrib>Berrocal, Audina M., MD</creatorcontrib><creatorcontrib>Davis, Janet L., MD</creatorcontrib><creatorcontrib>Smiddy, William E., MD</creatorcontrib><creatorcontrib>Townsend, Justin, MD</creatorcontrib><creatorcontrib>Miller, Darlene, CIC, DHSc</creatorcontrib><creatorcontrib>Flynn, Harry W., MD</creatorcontrib><title>Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Results The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22/52 (42%) to levofloxacin, 20/54 (37%) to ciprofloxacin, 16/47 (34%) to moxifloxacin, and 3/13 (23%) to gatifloxacin. Conclusion Causative organisms and visual outcomes are similar to those reported in the prior decade. 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Si, Nancy, BS ; Relhan, Nidhi, MD ; Kuriyan, Ajay E., MD ; Albini, Thomas A., MD ; Berrocal, Audina M., MD ; Davis, Janet L., MD ; Smiddy, William E., MD ; Townsend, Justin, MD ; Miller, Darlene, CIC, DHSc ; Flynn, Harry W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-d79a93b5fa1b28293fb27290e3514b092a44551458626b1b9721f2b3de08c8893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Cataract Extraction - adverse effects</topic><topic>Cataract Extraction - methods</topic><topic>Cataracts</topic><topic>Cornea - diagnostic imaging</topic><topic>Cornea - surgery</topic><topic>Endophthalmitis - diagnosis</topic><topic>Endophthalmitis - drug therapy</topic><topic>Endophthalmitis - etiology</topic><topic>Eye Infections, Bacterial - diagnosis</topic><topic>Eye Infections, Bacterial - drug therapy</topic><topic>Eye Infections, Bacterial - etiology</topic><topic>Eye surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Light</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ophthalmology</topic><topic>Organisms</topic><topic>Retrospective Studies</topic><topic>Sheep</topic><topic>Staphylococcal Infections - diagnosis</topic><topic>Staphylococcal Infections - drug therapy</topic><topic>Staphylococcal Infections - etiology</topic><topic>Staphylococcus - isolation & purification</topic><topic>Surgical Wound Infection - diagnosis</topic><topic>Surgical Wound Infection - drug therapy</topic><topic>Surgical Wound Infection - etiology</topic><topic>Time Factors</topic><topic>Visual Acuity</topic><topic>Vitreous Body - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yannuzzi, Nicolas A., MD</creatorcontrib><creatorcontrib>Si, Nancy, BS</creatorcontrib><creatorcontrib>Relhan, Nidhi, MD</creatorcontrib><creatorcontrib>Kuriyan, Ajay E., MD</creatorcontrib><creatorcontrib>Albini, Thomas A., MD</creatorcontrib><creatorcontrib>Berrocal, Audina M., MD</creatorcontrib><creatorcontrib>Davis, Janet L., MD</creatorcontrib><creatorcontrib>Smiddy, William E., MD</creatorcontrib><creatorcontrib>Townsend, Justin, MD</creatorcontrib><creatorcontrib>Miller, Darlene, CIC, DHSc</creatorcontrib><creatorcontrib>Flynn, Harry W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yannuzzi, Nicolas A., MD</au><au>Si, Nancy, BS</au><au>Relhan, Nidhi, MD</au><au>Kuriyan, Ajay E., MD</au><au>Albini, Thomas A., MD</au><au>Berrocal, Audina M., MD</au><au>Davis, Janet L., MD</au><au>Smiddy, William E., MD</au><au>Townsend, Justin, MD</au><au>Miller, Darlene, CIC, DHSc</au><au>Flynn, Harry W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>174</volume><spage>155</spage><epage>159</epage><pages>155-159</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><coden>AJOPAA</coden><abstract>Abstract Purpose To report the clinical features, causative organisms, and visual acuity (VA) outcomes associated with acute-onset endophthalmitis after clear corneal cataract surgery over the past two decades. Design Retrospective case series. Methods Clinical and microbiology records were reviewed for 63 eyes of 63 patients who presented to a tertiary referral center between 2006 and 2015 with culture-positive endophthalmitis occurring within 6 weeks of clear corneal cataract surgery. Results The mean time between surgery and diagnosis of endophthalmitis was 8 days (median 6 days). The initial treatment included intravitreal vancomycin and ceftazidime in 59 of 63 (94%) eyes and intravitreal vancomycin and amikacin in 4 of 63 (6%) eyes. Intravitreal dexamethasone was used in 50 of 63 (79%) eyes. A vitreous tap and injection with antibiotics was performed as the initial treatment in 57 of 63 (90%) eyes and pars plana vitrectomy in 6 of 63 (10%) eyes. Coagulase-negative Staphylococcus was isolated in 39 of 63 (62%) eyes, Staphylococcus aureus in 7 of 63 (11%) eyes, and Streptococcus species in 7 of 63 (11%) eyes. A VA of ≥20/40 was achieved in 24 of 63 (38%) eyes. None of the gram-positive isolates were vancomycin resistant. Twenty-four of 49 isolates (49%) were sensitive to cephalothin, cefazolin, and cefuroxime. Sensitivity to fluoroquinolones included 22/52 (42%) to levofloxacin, 20/54 (37%) to ciprofloxacin, 16/47 (34%) to moxifloxacin, and 3/13 (23%) to gatifloxacin. Conclusion Causative organisms and visual outcomes are similar to those reported in the prior decade. In the current study, a number of isolates were resistant to cephalosporins and fluoroquinolones.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27889501</pmid><doi>10.1016/j.ajo.2016.11.006</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Cataract Extraction - adverse effects Cataract Extraction - methods Cataracts Cornea - diagnostic imaging Cornea - surgery Endophthalmitis - diagnosis Endophthalmitis - drug therapy Endophthalmitis - etiology Eye Infections, Bacterial - diagnosis Eye Infections, Bacterial - drug therapy Eye Infections, Bacterial - etiology Eye surgery Female Follow-Up Studies Humans Laboratories Light Male Middle Aged Ophthalmology Organisms Retrospective Studies Sheep Staphylococcal Infections - diagnosis Staphylococcal Infections - drug therapy Staphylococcal Infections - etiology Staphylococcus - isolation & purification Surgical Wound Infection - diagnosis Surgical Wound Infection - drug therapy Surgical Wound Infection - etiology Time Factors Visual Acuity Vitreous Body - microbiology |
| title | Endophthalmitis After Clear Corneal Cataract Surgery: Outcomes Over Two Decades |
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