Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Acute endophthalmitis poses a significant threat to vision.
• Antibiotic resistance and corticosteroid use are key factors influencing treatment efficacy.
• Understanding these factors is crucial for optimizing visual outcomes.

Purpose of the Study:

• To investigate the impact of antibiotic resistance, intravitreal antibiotics, and systemic corticosteroids on visual outcomes in acute endophthalmitis.
• To assess the effectiveness of current treatment protocols.

Main Methods:

• A study of 226 eyes with acute endophthalmitis treated with a standardized protocol.
• Assessment of visual outcomes up to 12 months, correlated with biopsy results, antibiotic resistance, and treatment regimens.
• Vitreous and anterior chamber biopsies were analyzed for culture positivity.

Main Results:

• Vitreous biopsies showed higher culture positivity (41.1%) than anterior chamber biopsies (21.6%).
• Significant antibiotic resistance was observed for amikacin (24.7%), vancomycin (31.5%), and moxifloxacin (16.1%).
• Early systemic corticosteroids did not impact visual outcomes; endophthalmitis post-cataract surgery and vancomycin use were linked to better outcomes (BCVA ≥ 20/40).

Conclusions:

• Intravitreal antibiotics, despite resistance, achieve favorable visual outcomes (BCVA > 20/200 in 50%, ≥20/40 in 33%).
• Early intervention with intravitreal antibiotics is critical and should not be delayed.
• Treatment protocols should consider antibiotic resistance patterns.