Endophthalmitis Caused by Enterococcus Gallinarum Following Intravitreal Bevacizumab for Diabetic Macular Edema

Endophthalmitis caused by Enterococcus gallinarum is rare. This organism is often resistant to vancomycin, but sensitive to beta-lactams. Visual outcomes for endophthalmitis caused by enterococci are typically poor. This report describes the first documented case of acute-onset exogenous endophthalmitis due to E. gallinarum following intravitreal injection. A 46-year-old man presented with acute-onset exogenous endophthalmitis after intravitreal injection with bevacizumab in the right eye. Vitreous aspiration and culture identified E. gallinarum. Initial treatment was intravitreal ceftazidime 2.25 mg, vancomycin 1.00 mg, and dexamethasone 0.4 mg. The patient underwent pars plana vitrectomy with anterior chamber washout and intravitreal ceftazidime 2.25 mg and amikacin 0.4 mg. This isolate was susceptible to amikacin, but resistance to aminoglycosides has been reported. Although this isolate was sensitive to the administered antibiotics, the visual outcome was poor. Presenting vision was hand motion, and best-corrected visual acuity was light perception at postoperative 6-month follow-up. Beta-lactams (eg, ceftazidime) provide consistent coverage against E. gallinarum.