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Lee and Park: Clinical Results of Bacterial Endophthalmitis: Bacterial Culture and Visual Acuity Outcomes
Original Article

J Korean Ophthalmol Soc 2011;52(10):1173-1181.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1173

Clinical Results of Bacterial Endophthalmitis: Bacterial Culture and Visual Acuity Outcomes

Na Eun Lee, MD1, Jong Mun Park, MD, PhD1, 2

1Department of Ophthalmology, School of Medicine, Gyeongsang National University, Jinju, Korea

2Korea Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Jong Mun Park, MD, PhD Department of Ophthalmology, Gyeongsang National University Hospital #90 Chiram-dong, Jinju 660-702, Korea Tel: 82-55-750-8167, Fax: 82-55-758-4158, E-mail: parkjm@gnu.ac.kr

Received 6 August 2010       Accepted 22 April 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinical characteristics of bacterial culture, and visual outcome in patients with acute endophthalmitis.

Methods

Clinical records of patients treated for acute endophthalmitis in GNUH from 2000 to 2009 were reviewed. The specimens for culture were obtained from the anterior chamber or vitreous. Clinical outcome measures were bacterial culture, culture rate, and final visual acuity.

Results

Cultures (total 59 cases) showed bacterial growth in 37 cases (63%). Among 35 cases vitreous specimens, bacteria growth was found in 22 cases (63%), and from the 27 anterior chamber specimens, 12 cases (44%) were culture positive. From these 37 bacterial-positive cultures, 11 (30%) were coagulase negative Staphylococcus species, 16 (43.0%) were other Gram-positive species, 9 (24%) were Gram-negative species, and 1 (3%) produced a polymicrobial culture. Final visual acuity above 0.5 was achieved in 16 of 59 (27%) cases and coagulase negative Staphylococcus species had the greatest proportion being 5 of 11 (45%).

Conclusions

The bacterial culture positivity rate in bacterial endophthalmitis was 63%, and the culture yield rate from the vitreous was higher than the anterior chamber aqueous samples. Coagulase negative Staphylococcus species were the most common causative organisms and showed the best final visual outcome in endophthalmitis.

Keywords: Bacterial endophthalmitis, Culture

References

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Figure 1.
Correlation of initial visual acuity with final visual acuity (Spearman's rank correlation coefficent = 0.395, p = 0.002).
jkos-52-1173f1.tif
Figure 2.
Correlation of the time from onset of symptoms to operation with final visual acuity (Spearman's rank correlation coefficent = 0.159, p = 0.230).
jkos-52-1173f2.tif
Table 1.
Characteristics of cases with bacterial endophthalmitis
Characteristics N (%) Mean ± SD*
Sex
 Male 24 (40.7)
 Female 35 (59.3)
Age (yr) 64.97 ± 14.98
Past medical history
 No disease 32 (54.2)
 Chronic disease 25 (42.4)
 Cancer 4 (6.8)
Hypopyon
 Positive 41 (69.5)
 Negative 18 (30.5)
Time from causative operaton or trauma to onset of symptom (day)
 Cataract surgery related cases 16.4 ± 58.07
 Trauma related cases 0.44 ± 0.53
 Bleb related cases 2089.4 ± 1545.19
 Intravitreal injection related cases 4
Time from signs of endophthalmitis to surgery (day) 4.92 ± 12.24
Follow up period (mon) 15 ± 21.67

* SD = standard deviation.

Table 2.
Frequency of organisms during last 10 years
Organism 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
No growth 2 4 4 2 3 4 0 1 1 2
Gram positive 0 5 0 3 3 4 2 2 2 4
 Coagulase negative Staphylococcus species
  Staphylococcus epidermidis 1 1 2 2 1 1
  Coagulase Negative Staphylococcus 1 1
  Staphylococcus warnery 1
Gram (+) others
  Staphylococcus aureus 1 1
  Streptococcus pneumoniae 1 1 1
  Viridans group streptococcus 1
  Enterococcus faecalis 1 1 1 1 1
  Bacillus cereus 1 1 1
Gram negative 1 0 0 0 5 0 0 1 1 1
  Morganella morganii 1
  Pantoae 1
  Burkholderia cepacia 1
  Burkholderia mallei 1
  Alcaligenes xyloxidans 3
  Sphingomonas paucimobilis 1
  Pseudomonas aeruginosa 1
Polymicrobial
  MRSA & S. pneumoniae 1
Table 3.
Correlation of final visual acuity with causative organism
Organism Final visual acuity (Snellen scale)
LP*(−) LP*(+) HM† < 0.02 0.02 ≤ & < 0.1 0.1 ≤& ≤ 0.4 0.4 <
No growth 1 0 3 4 2 6 6 22
Gram positive
 Coagulase negative Staphylococcus species 1 0 0 1 0 4 5 11
  Staphylococcus epidermidis 3 5 8
  Coagulase Negative Staphylococcus 1 1 2
  Staphylococcus warnery 1 1
Gram (+) others
  Staphylococcus aureus 0 0 0 1 0 1 0 2
  Streptococcus pneumoniae 3 0 0 0 0 0 1 4
  Viridans group streptococcus 1 0 0 0 0 0 0 1
  Enterococcus faecalis 2 1 1 0 1 1 0 6
  Bacillus cereus 2 1 0 0 0 0 0 3
Gram negative
  Morganella morganii 0 0 0 0 0 1 0 1
  Pantoae 0 0 0 0 0 1 0 1
  Burkholderia cepacia 0 0 0 0 0 1 0 1
  Burkholderia mallei 0 0 0 0 0 0 1 1
  Alcaligenes xyloxidans 0 0 0 0 0 0 3 3
  Sphingomonas paucimobilis 0 0 0 1 0 0 0 1
  Pseudomonas aeruginosa 0 1 0 0 0 0 0 1
Polymicrobial
  MRSA & S. pneumoniae 0 0 1 0 0 0 0 1
Total 10 3 5 7 3 15 16 59

* LP = light perception

† HM = hand motion.

Table 4.
Final visual acuity related to the cause
Cause Number of cases Mean initial VA* ± SD† Mean final VA* ± SD† (Snellen VA*)
Cataract operation 40 0.005 ± 0.014 0.310 ± 0.324
Trauma 9 0.002 ± 0.007 0.212 ± 0.374
Bleb associated 5 0.168 ± 0.095 0.360 ± 0.288
Endogenous 4 0.001 ± 0.002 LP‡ (−) ∼ HM§
IVB∏ 1 HM§ FC**

p = 0.031, Kruskal-Wallis test.

* VA = visual acuity (Snellen scale)

† SD = standard deviation

‡ LP = light perception

§ HM = hand motion

∏ IVB = intravitreal Bevacizumab injection

** FC = finger count.

Table 5.
Initial visual acuity and final visual acuity related to a kind of operation
LP† (−) LP† (+) HM‡ <0.02 0.02 ≤ & < 0.1 0.1 ≤ & ≤ 0.4 0.4 <
Initial VA* ACI§ / IVA∏ 2 3 5 2 2 1 0
PPV** 0 6 29 8 2 0 0
Final VA* ACI§ / IVA∏ 5 0 1 0 1 2 6
PPV** 6 3 4 7 2 14 9

* VA = visual acuity (Snellen scale)

† LP = light perception

‡ HM = hand motion

§ ACI = anterior chamber irrigation

∏ IVA = intravitreal injection of antibiotics

** PPV = pars plana vitrectomy.

Table 6.
Correlation of final visual acuity with operation method
Operation Number of cases Mean final VA* ± SD†(Snellen VA*)
Without vitrectomy 14 0.333 ± 0.341
With vitrectomy 45 0.254 ± 0.319

p = 0.600, Mann-Whitney U test.

* VA = visual acuity (Snellen scale)

† SD = standard deviation.

Table 7.
Correlation of final visual acuity with the outcome of culture
Number of cases Mean final VA* ± SD†(Snellen VA*)
Positive culture 37 0.273 ± 0.344
Negative culture 22 0.273 ± 0.292

p = 0.493, Mann-Whitney U test.

* VA = visual acuity (Snellen scale)

† SD = standard deviation.

Table 8.
Correlation of culture specimen with the outcome of culture
Culture specimen Positive culture Negative culture Total
Aqueous humor 12 15 27
Vitreus 22 13 35
Bleb 5 0 5
Cornea 0 1 1

p = 0.018, Fisher's exact test.

Table 9.
Antibiotics susceptibility
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Gram positive Ciprofloxacin
 Susceptible 3 1 3 1 1 2
 Intermediate
 Resistant 1 2 1 1 2 1 3
Ofloxacin
 Susceptible 2 1
 Intermediate
 Resistant
Levofloxacin
 Susceptible 1 2
 Intermediate
 Resistant 1 1 1 1 3
Moxifloxacin
 Susceptible 2 1 1 2
 Intermediate 1
 Resistant 1 3
Oxacillin
 Susceptible 1 1 1 1
 Intermediate
 Resistant 2 2 2 1 1 1 2
Vancomycin 4 2 2 4 2 2 1 3
 Susceptible 4 2 2 4 2 2 1 3
 Intermediate 1
 Resistant 1
Gram negative Tobramycin
 Susceptible 1 1
 Intermediate
 Resistant 5 1
Ceftazidime
 Susceptible 1 3 1 1 1
 Intermediate 2
 Resistant
Amikacin
 Susceptible 1 2 1 1
 Intermediate 1
 Resistant 2 1
Ciprofloxacin
 Susceptible 1 2 1 1 1
 Intermediate 1
 Resistant 2
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