Sridhar Jayanth, Kuriyan Ajay E, Flynn Harry W, Miller Darlene
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Retina. 2015 Jun;35(6):1101-6. doi: 10.1097/IAE.0000000000000469.
To report the clinical features, antibiotic susceptibilities, and visual outcomes associated with endophthalmitis caused by Pseudomonas aeruginosa.
A consecutive case series. Microbiology database records were retrospectively reviewed for all patients with endophthalmitis caused by P. aeruginosa from January 1, 2002, to December 31, 2012, at a large university referral center. The corresponding clinical records were then reviewed to evaluate the endophthalmitis clinical features and treatment outcomes.
In the 12 patients identified, clinical settings included postcataract surgery (n = 4), postpenetrating keratoplasty (n = 3), endogenous source (n = 2), post-pars plana vitrectomy (n = 1), trabeculectomy bleb-associated setting (n = 1), and glaucoma drainage implant-associated setting (n = 1). All patients presented with hypopyon. Presenting visual acuity was hand motions or worse in all cases. All isolates were susceptible to ceftazidime and levofloxacin. When comparing isolates in this study with isolates from a previous study (1987 to 2001), the minimal inhibitory concentration required to inhibit 90% of isolates (MIC 90, in micrograms per milliliter) remained the same for ceftazidime (8), ciprofloxacin (0.5), imipenem (4), tobramycin (0.5), and amikacin (4). Initial treatment strategies were vitreous tap and injection (n = 9) and pars plana vitrectomy with intravitreal antibiotics (n = 3). Final visual acuity was light perception or worse in 11 of the 12 patients (92%). Five patients underwent enucleation (42%).
All isolates were susceptible to ceftazidime and levofloxacin, and all MIC 90s for isolates in the current period compared with isolates from 1987 to 2001 remained identical. Despite early and appropriate treatment, outcomes were generally poor with a high rate of enucleation.
报告铜绿假单胞菌所致眼内炎的临床特征、抗生素敏感性及视力转归。
连续病例系列研究。对2002年1月1日至2012年12月31日在某大型大学转诊中心确诊为铜绿假单胞菌所致眼内炎的所有患者的微生物学数据库记录进行回顾性分析。随后查阅相应临床记录以评估眼内炎的临床特征及治疗效果。
共纳入12例患者，临床情况包括白内障术后（4例）、穿透性角膜移植术后（3例）、内源性感染（2例）、玻璃体切割术后（1例）、小梁切除术后滤过泡相关感染（1例）及青光眼引流植入物相关感染（1例）。所有患者均有前房积脓。所有病例就诊时视力均为手动或更差。所有分离菌株对头孢他啶和左氧氟沙星敏感。将本研究中的分离菌株与先前一项研究（1987年至2001年）中的分离菌株进行比较时，抑制90%分离菌株所需的最低抑菌浓度（MIC90，单位为微克/毫升），头孢他啶（8）、环丙沙星（0.5）、亚胺培南（4）、妥布霉素（0.5）和阿米卡星（4）保持不变。初始治疗策略为玻璃体穿刺注药（9例）和平坦部玻璃体切割联合玻璃体内注射抗生素（3例）。12例患者中有11例（92%）最终视力为光感或更差。5例患者（42%）接受了眼球摘除术。
所有分离菌株对头孢他啶和左氧氟沙星敏感，与1987年至2001年的分离菌株相比，当前时期分离菌株的所有MIC90均保持一致。尽管进行了早期且恰当的治疗，但总体预后较差，眼球摘除率较高。
