Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Standard Chartered Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Eur J Ophthalmol. 2023 Sep;33(5):1997-2005. doi: 10.1177/11206721231163353. Epub 2023 Mar 12.
To report the clinical settings, management and factors affecting outcomes in multi-drug resistant (MDR) and extensively-drug resistant (XDR) endophthalmitis.
Retrospective, consecutive, non-comparative interventional case series. Cases of MDR and XDR endophthalmitis from January 2012 to December 2020 treated at our tertiary eye care center were included. Data collected included clinical data, anatomic and functional outcome, isolated micro-organisms, and culture sensitivity.
This study included 29 eyes of 29 patients with MDR/XDR endophthalmitis. Mean age at presentation was 60.27 ± 14.9 years (median 63). Commonest clinical setting was acute post-operative endophthalmitis in 27 cases (93.1%). Concurrent corneal infiltrate was present in 11 eyes (37.9%). Initial intervention in 19 eyes (65.5%) was vitrectomy, 2 of which underwent endoscopic pars plana vitrectomy. Mean number of interventions was 3.34 ± 1.44 (median 4). Mean follow up was 3.25 ± 3.07 months (median 2). Sensitivity to ceftazidime was 48.28%. All isolates were sensitive to colistin. Mean visual acuity at last follow up in logMAR was 2.64 ± 1.48 (median 3.5). Seven eyes (24.13%) were NPL (nil perception of light) at the last follow up. Two eyes (6.9%) underwent evisceration. Nine eyes (31.03%) had a favourable anatomic and functional outcome. Eyes without a corneal infiltrate at presentation were found to have a favourable anatomic and favourable functional outcome (OR 11.91, P < 0.04, CI 1.08 to 130.93).
Corneal involvement at presentation is associated with poorer outcomes in MDR and XDR endophthalmitis. There is a potential role of higher newer antibiotics especially colistin in the management of these cases.
报告多药耐药（MDR）和广泛耐药（XDR）眼内炎的临床情况、治疗方法及影响结局的因素。
回顾性、连续、非对照的干预性病例系列研究。纳入 2012 年 1 月至 2020 年 12 月在我院三级眼科中心治疗的 MDR 和 XDR 眼内炎患者。收集的资料包括临床资料、解剖和功能结局、分离的微生物和培养敏感性。
本研究纳入了 29 例 29 只眼 MDR/XDR 眼内炎患者。发病时的平均年龄为 60.27±14.9 岁（中位数 63 岁）。最常见的临床类型是 27 例（93.1%）急性术后眼内炎。11 只眼（37.9%）同时存在角膜浸润。19 只眼（65.5%）的初始干预措施是玻璃体切除术，其中 2 只眼行经睫状体平坦部的玻璃体切除术。平均干预次数为 3.34±1.44（中位数 4）。平均随访时间为 3.25±3.07 个月（中位数 2）。头孢他啶的敏感性为 48.28%。所有分离株均对黏菌素敏感。末次随访时 logMAR 视力平均为 2.64±1.48（中位数 3.5）。7 只眼（24.13%）在末次随访时无光感。2 只眼（6.9%）行眼内容剜除术。9 只眼（31.03%）获得了良好的解剖和功能结局。发病时无角膜浸润的眼，解剖和功能结局均较好（OR 11.91，P<0.04，95%CI 1.08 至 130.93）。
发病时的角膜受累与 MDR 和 XDR 眼内炎的不良结局相关。新型更高浓度抗生素（特别是黏菌素）在这些病例的治疗中可能有一定作用。
