1 Medical Center Drive, West Virginia University Eye Institute, Morgantown, WV, 26506, USA.
University of Southern California Roski Eye Institute, 1450 San Pablo St., Suite 4700, Los Angeles, CA, 90013, USA.
Int Ophthalmol. 2022 Oct;42(10):3153-3163. doi: 10.1007/s10792-022-02315-4. Epub 2022 May 23.
To report the microbiological spectrum, antimicrobial resistance patterns, and visual outcomes in patients with endogenous endophthalmitis (EE).
This was a retrospective study of 50 patients with culture-positive EE managed in a tertiary referral center between October 2009 and 2019. Clinical, microbiology analysis, and antimicrobial resistance were reviewed. A multivariable linear regression analysis was used for identifying risk factors associated with worse visual outcomes.
Fifty organisms were identified, 62% bacterial and 38% fungal. The most common bacterial organism was Staphylococcus aureus (75% methicillin resistant), and Candida was the most common fungal species. Multidrug resistance was observed in methicillin-resistant Staphylococcus aureus (MRSA) isolates against clindamycin, daptomycin, and fluoroquinolones. The distributions of the final visual acuity (VA) between the bacterial and fungal groups were significantly different, and the visual outcomes in the bacterial group tended to be worse (p = 0.01). The distributions of enucleation status were significantly higher in bacterial EE (35%) than fungal EE (5.3%) (p = 0.02). Results from the multivariable linear regression analysis revealed that older age was significantly associated with worse visual outcome (coef = 0.03; p = 0.02), while fungal infections were associated with better outcomes (coef = - 0.87; p = 0.01). Intravenous drug use (coef = 0.87; p = 0.054) was a marginally significant factor associated with worse visual outcomes.
There was a higher prevalence of bacterial organisms than fungal species among EE. Bacterial EE was associated with worse visual outcomes and higher enucleation rates than fungal EE. Multidrug resistance was prevalent among MRSA isolates. Older age and intravenous drug use may be factors associated with poor prognosis.
报告内生性眼内炎（EE）患者的微生物谱、抗菌药物耐药模式和视力结果。
这是一项回顾性研究，纳入了 2009 年 10 月至 2019 年在一家三级转诊中心接受治疗的 50 例培养阳性 EE 患者。对临床、微生物学分析和抗菌药物耐药性进行了回顾。采用多变量线性回归分析确定与较差视力结果相关的危险因素。
共鉴定出 50 种微生物，其中 62%为细菌，38%为真菌。最常见的细菌病原体是金黄色葡萄球菌（75%耐甲氧西林），而真菌中最常见的物种是念珠菌。耐甲氧西林金黄色葡萄球菌（MRSA）分离株对克林霉素、达托霉素和氟喹诺酮类药物表现出多重耐药性。细菌组和真菌组的最终视力（VA）分布有显著差异，细菌组的视力结果较差（p=0.01）。细菌性 EE 组的眼球摘除率（35%）明显高于真菌性 EE 组（5.3%）（p=0.02）。多变量线性回归分析结果显示，年龄较大与视力结果较差显著相关（系数=0.03；p=0.02），而真菌感染与较好的结果相关（系数=-0.87；p=0.01）。静脉吸毒（系数=0.87；p=0.054）是与视力结果较差相关的一个边缘显著因素。
EE 中细菌病原体的流行率高于真菌。与真菌性 EE 相比，细菌性 EE 与较差的视力结果和较高的眼球摘除率相关。MRSA 分离株普遍存在多重耐药性。年龄较大和静脉吸毒可能是预后不良的相关因素。
