Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis: a 10-year retrospective study

Eun Young Choi, Jae Yong Han, Hyukmin Lee, Sungchul Lee, Hyoung Jun Koh, Sung Soo Kim, Min Kim

Research output: Contribution to journalArticle

Abstract

Purpose: Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE. Methods: The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors. Results: Among 171 eyes, 121 (70.8%) eyes developed IE after intraocular surgery (cataract surgery, 46.3%; intraocular injection, 13.2%), 37 (21.6%) eyes developed IE endogenously, and 9 (5.3%) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4%) and Klebsiella pneumoniae (7.0%). In total, 72.6% of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P =.027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P =.003). Conclusion: Antibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.

Original languageEnglish
Pages (from-to)805-813
Number of pages9
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume257
Issue number4
DOIs
Publication statusPublished - 2019 Apr 5

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Endophthalmitis
Vitrectomy
Microbial Drug Resistance
Retrospective Studies
Intravitreal Injections
Intraocular Injections
Staphylococcal Pneumonia
Klebsiella pneumoniae
Cephalosporins
Blindness
Vancomycin
Drug Resistance
Tertiary Care Centers
Cataract
Medical Records
Logistic Models
Regression Analysis
Anti-Bacterial Agents
Wounds and Injuries
Therapeutics

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

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title = "Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis: a 10-year retrospective study",
abstract = "Purpose: Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE. Methods: The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors. Results: Among 171 eyes, 121 (70.8{\%}) eyes developed IE after intraocular surgery (cataract surgery, 46.3{\%}; intraocular injection, 13.2{\%}), 37 (21.6{\%}) eyes developed IE endogenously, and 9 (5.3{\%}) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4{\%}) and Klebsiella pneumoniae (7.0{\%}). In total, 72.6{\%} of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P =.027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P =.003). Conclusion: Antibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.",
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Impact of antibiotic resistance of pathogens and early vitrectomy on the prognosis of infectious endophthalmitis : a 10-year retrospective study. / Choi, Eun Young; Han, Jae Yong; Lee, Hyukmin; Lee, Sungchul; Koh, Hyoung Jun; Kim, Sung Soo; Kim, Min.

In: Graefe's Archive for Clinical and Experimental Ophthalmology, Vol. 257, No. 4, 05.04.2019, p. 805-813.

Research output: Contribution to journalArticle

TY - JOUR

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AU - Choi, Eun Young

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AU - Koh, Hyoung Jun

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AU - Kim, Min

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