Choi Eun Young, Han Jae Yong, Lee Hyukmin, Lee Sung Chul, Koh Hyoung Jun, Kim Sung Soo, Kim Min
Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 135-720, South Korea.
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2019 Apr;257(4):805-813. doi: 10.1007/s00417-019-04261-x. Epub 2019 Feb 13.
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.
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.
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).
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.
感染性眼内炎（IE）是一种严重的并发症，即使经过治疗也可能导致失明。然而，抗生素耐药性和早期玻璃体切除术对其预后的影响鲜有文献记载。本研究调查了病原体的抗生素耐药性和早期玻璃体切除术对IE预后的影响。
回顾性分析2007年至2016年在一家三级转诊中心接受IE治疗的171例患者的病历，分析其病因、病原体、对万古霉素或第三代头孢菌素的耐药性、治疗类型和时间以及视力结果。采用多变量逻辑回归分析确定显著的预后因素。
在171只眼中，121只（70.8%）眼在眼内手术后发生IE（白内障手术，46.3%；眼内注射，13.2%），37只（21.6%）眼内源性发生IE，9只（5.3%）眼在创伤后发生IE。主要致病病原体为金黄色葡萄球菌（9.4%）和肺炎克雷伯菌（7.0%）。总共72.6%的已鉴定病原体表现出抗生素耐药性。抗生素耐药性与最终视力较差相关（P = 0.027）。与在延迟玻璃体切除术前行单纯眼内抗菌注射的眼相比，在发病24小时内接受早期玻璃体切除术联合眼内抗菌注射治疗的眼的视力预后更好（P = 0.003）。
引起IE的生物体的抗生素耐药性是最重要的预后因素之一。早期玻璃体切除术（即24小时内）可能有助于获得更好的视力结果。可推荐立即进行玻璃体切除术，尤其是在由对经验性使用的抗生素耐药的生物体引起的IE病例中。
