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Nine-Year Analysis of Isolated Pathogens and Antibiotic Susceptibilities of Infectious Endophthalmitis from a Large Referral Eye Center in Southern China

Authors Lin L, Mei F, Liao J, Yang Y, Duan F, Lin X

Received 24 October 2019

Accepted for publication 2 February 2020

Published 13 February 2020 Volume 2020:13 Pages 493—500

DOI https://doi.org/10.2147/IDR.S235954

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Eric Nulens


Lixia Lin,* Feng Mei,* Jingyu Liao, Yao Yang, Fang Duan, Xiaofeng Lin

Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaofeng Lin; Fang Duan
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, People’s Republic of China
Tel +86 18922103830; +86 13710790313
Email linxiaof@mail.sysu.edu.cn; duanfangg@126.com

Purpose: To analyze the pathogen spectrum of isolated pathogens and antibiotic susceptibility trends of infectious endophthalmitis over 9 years from a large referral eye center in southern China.
Methods: Data from all inpatients who were clinically diagnosed with infectious endophthalmitis and underwent microbiological evaluation at the Zhongshan Ophthalmic Center from January 2010 to December 2018 were collected retrospectively and analyzed according to different clinical etiologies.
Results: A total of 816 cases were collected in the study. Open-globe injuries had caused 473 (57.97%) cases, 70 (8.58%) cases presented endophthalmitis after infectious keratitis, 156 (19.12%) cases were postoperative, and endogenous causes accounted for 117 (14.34%) cases. Among the 309 culture-positive cases, the predominant pathogen for both postoperative and posttraumatic endophthalmitis was gram-positive cocci (59.52% and 49.72%, respectively). Regarding keratitis-related endophthalmitis, the main pathogens were filamentous fungi (57.58%) and gram-negative bacilli (30.30%). The pathogens of endogenous endophthalmitis were almost evenly distributed among gram-positive cocci, gram-negative bacilli, and fungi. Eighty-five (10.42%) cases underwent evisceration/enucleation, including 42 cases secondary to keratitis-related endophthalmitis. The incidence of evisceration/enucleation was much higher in keratitis-related endophthalmitis than the total endophthalmitis population (χ 2 =123.61, P< 0.001). Overall bacteria showed high susceptibility to fluoroquinolones (75.36– 100.00%). Gram-positive cocci showed much higher sensitivity to cephalosporins compared to gram-negative bacilli (85.11– 92.59% vs 25.42– 35.72%). For the five first-line antibiotics analyzed for time trend of susceptibility, four exhibited a significant decrease of susceptibility from 2010– 2014 to 2015– 2018.
Conclusion: Between 2010 and 2018, posttraumatic endophthalmitis was the most common form of the treated endophthalmitis in Zhongshan Ophthalmic Center. The causative pathogens varied according to different clinical settings. Even though the overall antibiotic susceptibilities were fairly high, we observed a substantial decrease of susceptibility for most first-line antibiotics.

Keywords: infectious endophthalmitis, pathogen spectrum, antibiotic resistance, time trend, evisceration/enucleation

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