Yannuzzi Nicolas A, Patel Nimesh A, Relhan Nidhi, Tran Kimberly D, Si Nancy, Albini Thomas A, Berrocal Audina M, Davis Janet L, Smiddy William E, Townsend Justin, Miller Darlene, Flynn Harry W
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Retina. 2018 May;2(5):396-400. doi: 10.1016/j.oret.2017.08.025. Epub 2017 Nov 2.
To report the clinical features, antibiotic susceptibilities, and visual acuity outcomes with endophthalmitis caused by methicillin-sensitive Staphylococcus epidermidis and methicillin-resistant S. epidermidis.
Retrospective case series.
All patients seeking treatment at a tertiary referral center between 2006 and 2016 with endophthalmitis caused by S. epidermidis.
All records were reviewed for patients with a clinical diagnosis of endophthalmitis and positive vitreous culture results for S. epidermidis. Data were compared with the prior series at the same institution.
Clinical settings, antibiotic susceptibilities, and visual acuity.
Among 96 eyes of 96 patients, the most common postprocedural clinical settings were cataract surgery (47/96 [49%]), intravitreal injection (21/96 [22%]), trauma (8/96 [8%]), glaucoma surgery (7/96 [7%]), and penetrating keratoplasty (5/96 [5%]). The initial treatment included intravitreal vancomycin and ceftazidime in 89 of 96 eyes (93%) and intravitreal vancomycin and amikacin in 7 of 96 eyes (7%). A vitreous tap and injection with antibiotics was performed as the initial treatment in 83 of 96 eyes (86%) and pars plana vitrectomy was performed in 13 of 96 eyes (14%). All isolates were sensitive to vancomycin in both decades. In the most recent series, visual acuity at last follow-up was 5/200 or better in 68 of 96 eyes (71%) compared with 71 of 86 eyes (83%) in the prior study. In the current study, susceptibility to methicillin and moxifloxacin was present in 45 of 96 eyes (47%) and 29 of 85 eyes (34%), respectively, compared with 34 of 86 eyes (40%) and 27 of 39 eyes (69%) in the prior study. Final visual acuity was not significantly different between those eyes that were methicillin or fluoroquinolone sensitive and those that were resistant.
In the current and prior series, all S. epidermidis isolates were sensitive to vancomycin. Visual acuity outcomes were not dependent on methicillin or fluoroquinolone sensitivity.
报告由甲氧西林敏感表皮葡萄球菌和甲氧西林耐药表皮葡萄球菌引起的眼内炎的临床特征、抗生素敏感性及视力预后。
回顾性病例系列研究。
2006年至2016年间在一家三级转诊中心因表皮葡萄球菌引起眼内炎而寻求治疗的所有患者。
对所有临床诊断为眼内炎且玻璃体培养结果为表皮葡萄球菌阳性的患者记录进行回顾。将数据与同一机构之前的系列研究进行比较。
临床情况、抗生素敏感性及视力。
在96例患者的96只眼中，最常见的术后临床情况为白内障手术（47/96 [49%]）、玻璃体内注射（21/96 [22%]）、外伤（8/96 [8%]）、青光眼手术（7/96 [7%]）和穿透性角膜移植术（5/96 [5%]）。初始治疗包括96只眼中的89只（93%）采用玻璃体内注射万古霉素和头孢他啶，96只眼中的7只（7%）采用玻璃体内注射万古霉素和阿米卡星。96只眼中的83只（86%）以玻璃体穿刺并注射抗生素作为初始治疗，96只眼中的13只（14%）进行了玻璃体切割术。在这两个十年中，所有分离株对万古霉素均敏感。在最近的系列研究中，96只眼中的68只（71%）在最后一次随访时视力为5/200或更好，而之前的研究中86只眼中的71只（83%）达到该视力。在本研究中，96只眼中的45只（47%）对甲氧西林敏感，85只眼中的29只（34%）对莫西沙星敏感，而之前的研究中86只眼中的34只（40%）对甲氧西林敏感，39只眼中的27只（69%）对氟喹诺酮敏感。甲氧西林或氟喹诺酮敏感的眼与耐药的眼最终视力无显著差异。
在当前及之前的系列研究中，所有表皮葡萄球菌分离株对万古霉素均敏感。视力预后不取决于对甲氧西林或氟喹诺酮的敏感性。
