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CLINICAL PRESENTATION, MICROBIOLOGIC PROFILE AND FACTORS PREDICTING OUTCOMES IN BACILLUS ENDOPHTHALMITIS
Vivek P Dave1, Avinash Pathengay2, Ina Budhiraja1
1Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Purpose:
To describe the clinical presentation, microbiologic profile, and factors predicting outcomes in Bacillus endophthalmitis.
Methods:
Retrospective interventional case series. Eighty-six patients with culture-proven Bacillus endophthalmitis, from January 2001 to December 2015, underwent vitrectomy/vitreous biopsy and intravitreal antibiotic with or without steroid as appropriate. The undiluted vitreous biopsy was subjected to microbiologic evaluation. The duration of symptoms, presenting visual acuity, organisms isolated, influence of intravitreal dexamethasone with intravitreal antibiotics, and type of initial intervention were examined for any clinical and statistical correlation in terms of odds ratio with the final visual outcome.
Results:
Trauma was the commonest etiology (n = 75; 87.2%). Mixed infection with other bacteria was seen in 11 patients. All Bacillus species were sensitive to gentamicin followed by ciprofloxacin (n = 85; 98.83%) and vancomycin (n = 81; 94.18%). Odds in favor of a favorable visual outcome were seen with clinical treatment within 48 hours of the symptoms (OR 25.47, 95% CI 2.45-254.16, P = 0.006), better presenting vision (OR 31.21, 95% CI 2.96-323.64, P = 0.004), and absence of polymicrobial infection (OR 18.03, 95% CI 0.9-344.4, P = 0.05). Only 20% of all treated patients regained ambulatory vision, and one fifth of all of them developed phthisis.
Conclusion:
Patients diagnosed with Bacillus endophthalmitis merit aggressive vitreous intervention guided by the culture-sensitivity report. Despite early and appropriate treat ment, the outcomes are generally poor.