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

Authors
 Eun Young Choi  ;  Jae Yong Han  ;  Hyukmin Lee  ;  Sung Chul Lee  ;  Hyoung Jun Koh  ;  Sung Soo Kim  ;  Min Kim 
Citation
 GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, Vol.257(4) : 805-813, 2019 
Journal Title
 GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 
ISSN
 0721-832X 
Issue Date
2019
MeSH
Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Aqueous Humor/microbiology ; Bacteria/isolation & purification ; Drug Resistance, Bacterial* ; Drug Resistance, Fungal* ; Endophthalmitis/diagnosis* ; Endophthalmitis/microbiology ; Endophthalmitis/therapy ; Eye Infections, Bacterial/diagnosis* ; Eye Infections, Bacterial/microbiology ; Eye Infections, Bacterial/therapy ; Female ; Fungi/isolation & purification ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Vitrectomy* ; Vitreous Body/microbiology ; Young Adult
Keywords
Antibiotic resistance ; Early vitrectomy ; Infectious endophthalmitis ; Intraocular antibiotic injection ; Prognostic factor
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.
Full Text
https://link.springer.com/article/10.1007%2Fs00417-019-04261-x
DOI
10.1007/s00417-019-04261-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Koh, Hyoung Jun(고형준) ORCID logo https://orcid.org/0000-0002-5932-8516
Kim, Min(김민) ORCID logo https://orcid.org/0000-0003-1873-6959
Kim, Sung Soo(김성수) ORCID logo https://orcid.org/0000-0002-0574-7993
Lee, Sung Chul(이성철) ORCID logo https://orcid.org/0000-0001-9438-2385
Lee, Hyuk Min(이혁민) ORCID logo https://orcid.org/0000-0002-8523-4126
Choi, Eun Young(최은영) ORCID logo https://orcid.org/0000-0002-1668-6452
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/170061
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