Clinical Presentations and Management Outcomes of Culture-Proven Mixed Bacterial and Fungal Endophthalmitis

To report the clinical features and management outcomes of mixed fungal and bacterial endophthalmitis.

Retrospective, consecutive non-comparative case series. Fifteen eyes of 15 patients were included from January 2009 to December 2019 with culture proven mixed fungal and bacterial endophthalmitis. Demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit.

The mean age of patients in this series was 34.2 ± 19.6 years (range: 5-61 years). Male preponderance was found in 14 (93.3%). Eight (53.3%) eyes had open globe injury, 5(33.3%) had postoperative endophthalmitis and one (6.6%) each with endogenous endophthalmitis and post-keratitis. Pars plana vitrectomy was done in eight (53.3%) eyes whereas vitreous tap alone was done in seven (46.7%) eyes. Gram positive cocci (n = 11, 73.3%) were the commonest bacterial isolates (n = 7, 46.6%). Staphylococcus aureus (n = 3, 20%) was the most common bacterial isolate. The commonest fungi were filamentous hyaline fungi (n = 5, 33.3%). An unfavorable visual outcome (VA<20/400) was seen in all the eyes. The mean duration of follow-up was 13 ± 18.3 months. Globe salvage was possible only in five (33.3%) eyes. The bacterial isolates were highly sensitive to all of the tested antibiotics.

Mixed fungal and bacterial endophthalmitis occur commonly in a setting of open-globe trauma. The presence of fungus concurrently leads to a very poor management outcome even if the bacterial isolate sensitivity is good.