Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Centre for Eye Research Australia, East Melbourne, Victoria, Australia.
Clin Exp Ophthalmol. 2020 Aug;48(6):813-820. doi: 10.1111/ceo.13768. Epub 2020 May 11.
This is the largest Gram-negative endophthalmitis specific series and provides important evidence to guide management.
Endophthalmitis is a sight-threatening emergency. Gram-negative infections are associated with poorer visual outcomes; however, there is limited literature pertaining to this uncommon condition.
Prospective case series.
All patients presenting with endophthalmitis to a tertiary institution over a 20-year period.
Data were collected prospectively and entered into a registry. Patients with microbiological evidence of Gram-negative infection were included in the analysis.
Final visual acuity (VA), precipitating events, causative organisms, antibiotic sensitivity profiles and risk factors for poor visual outcomes were reported.
One hundred Gram-negative organisms were isolated in 97 eyes. Final VA was worse than 6/60 in 65 (67.0%) eyes at follow-up and 29 (29.9%) eyes were eviscerated or enucleated. Microbial keratitis (26.8%, n = 26) and Pseudomonas aeruginosa (34.0%, n = 34) were the most common precipitating event and causative organism, respectively. Eight (8.0%) isolates were third-generation cephalosporin resistant; of which, 7 (88.0%) were sensitive to ciprofloxacin. Preceding microbial keratitis (OR = 13.16, P = .015) or P. aeruginosa infections (OR = 3.40, P = .045) were strongly associated with poorer visual outcomes (worse than 6/60).
Visual outcomes following Gram-negative endophthalmitis are extremely poor, with almost 30% of patients being eviscerated or enucleated. A majority of ceftazidime resistant organisms are sensitive to ciprofloxacin, providing evidence to support the empirical use of quinolones. Clinicians should be mindful that infections secondary to P. aeruginosa or microbial keratitis carry a particularly poor prognosis.
这是最大的革兰氏阴性眼内炎的特定系列，并提供了重要的证据来指导管理。
眼内炎是一种威胁视力的紧急情况。革兰氏阴性感染与较差的视力结果相关; 然而，关于这种罕见疾病的文献有限。
前瞻性病例系列。
在 20 年期间，所有在一家三级机构就诊的眼内炎患者。
数据前瞻性收集并输入登记处。分析中包括有革兰氏阴性感染微生物学证据的患者。
报道最终视力（VA）、诱发事件、病原体、抗生素敏感性谱和视力不良的危险因素。
在 97 只眼中分离出 100 种革兰氏阴性菌。随访时，65 只眼（67.0%）最终视力低于 6/60，29 只眼（29.9%）行眼球摘除或眼内容剜除。微生物性角膜炎（26.8%，n = 26）和铜绿假单胞菌（34.0%，n = 34）分别是最常见的诱发事件和病原体。8 株（8.0%）分离株对第三代头孢菌素耐药；其中 7 株（88.0%）对环丙沙星敏感。先前的微生物性角膜炎（OR = 13.16，P =.015）或铜绿假单胞菌感染（OR = 3.40，P =.045）与较差的视力结果（低于 6/60）密切相关。
革兰氏阴性眼内炎的视觉预后极差，近 30%的患者行眼球摘除或眼内容剜除。大多数头孢他啶耐药菌对环丙沙星敏感，为经验性使用喹诺酮类药物提供了证据。临床医生应注意，继发于铜绿假单胞菌或微生物性角膜炎的感染预后特别差。
