Endophthalmitis caused by enterococcus faecalis: antibiotic selection and treatment outcomes

To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns.

Retrospective, noncomparative, consecutive case series.

Records were reviewed of all patients with culture-positive endophthalmitis caused by E. faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001.

Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes.

Endophthalmitis caused by E. faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E. faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%).

E. faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E. faecalis usually is associated with poor visual outcomes.