Scott Ingrid U, Loo Roy H, Flynn Harry W, Miller Darlene
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Ophthalmology. 2003 Aug;110(8):1573-7. doi: 10.1016/S0161-6420(03)00502-5.
To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns.
Retrospective, noncomparative, consecutive case series.
Records were reviewed of all patients with culture-positive endophthalmitis caused by E. faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001.
Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes.
Endophthalmitis caused by E. faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E. faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%).
E. faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E. faecalis usually is associated with poor visual outcomes.
研究粪肠球菌所致眼内炎的临床情况、治疗策略及视力预后，并确定抗生素的敏感性和耐药模式。
回顾性、非对照、连续病例系列研究。
回顾1990年1月1日至2001年12月31日在巴斯科姆·帕尔默眼科研究所评估的所有粪肠球菌培养阳性的眼内炎患者的记录。
相关的既往手术操作、临床特征、所给予的治疗、抗生素敏感性和耐药模式以及最终视力结果。
29例患者的29只眼中确诊为粪肠球菌所致眼内炎。平均随访时间为17.8个月（范围0.1 - 86.7个月）。粪肠球菌所致眼内炎按发生频率递减依次与以下手术相关：29只眼中12只（41.4%）行白内障手术，29只眼中8只（27.6%）行小梁切除术，29只眼中4只（13.8%）行穿透性角膜移植术，29只眼中3只（10.3%）行白内障联合小梁切除术，29只眼中1只（3.5%）行引流管植入术，29只眼中1只（3.5%）行瞳孔成形术。分离菌株的耐药模式如下：23只眼中0只（0.0%）对万古霉素耐药，29只眼中0只（0.0%）对利奈唑胺耐药，14只眼中1只（7.1%）对环丙沙星耐药，16只眼中8只（50.0%）对庆大霉素（最低抑菌浓度＞8mg/L）耐药，29只眼中5只（17.2%）对高水平庆大霉素（最低抑菌浓度＞500mg/L）耐药，8只眼中7只（87.5%）对头孢唑林耐药，29只眼中29只（100.0%）对奎奴普丁/达福普汀耐药。感染前基线视力范围为20/30至手动。眼内炎发病时的视力范围为2/200至无光感。最终视力在2例（6.9%）中优于或等于20/50，3例（10.3%）中为20/60至20/400，10例（34.5%）中为5/200至手动，14例（48.3%）中为光感至无光感。
粪肠球菌通常对庆大霉素和头孢菌素耐药，但在所检测的所有分离菌株中对万古霉素敏感。粪肠球菌所致眼内炎通常视力预后较差。
