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Endophthalmitis in a pediatric population
Insights
Pediatric endophthalmitis, often following trauma, predominantly affects males. Prompt antibiotic treatment is crucial, even before culture results, as Gram-positive bacteria are common culprits.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Trauma Care
Background:
- Endophthalmitis in children is a serious condition requiring prompt diagnosis and management.
- Trauma is a more frequent cause of pediatric endophthalmitis compared to adult cases.
- Early identification and treatment are critical to preserve visual acuity.
Purpose of the Study:
- To analyze the clinical characteristics, causative organisms, and outcomes of suspected endophthalmitis in pediatric patients.
- To evaluate the impact of trauma on the incidence and presentation of pediatric endophthalmitis.
- To assess the correlation between microbiological findings and final visual acuity in affected children.
Main Methods:
- Retrospective analysis of 22 consecutive pediatric cases with suspected endophthalmitis.
- Review of patient demographics, injury history, microbiological culture results (anterior chamber, vitreous, wound), and visual outcomes.
- Assessment of time to diagnosis and initiation of antibiotic therapy.
Main Results:
- The majority of patients (68%) were male, with a mean age of 7.4 years.
- Trauma was the precipitating event in 86% of cases, a significantly higher proportion than in adult populations.
- Gram-positive organisms were identified in 75% of positive cultures, highlighting the need for broad-spectrum antibiotic coverage.
- Pre-culture antibiotic administration did not preclude positive culture results in 75% of cases.
- A positive culture did not strongly correlate with poor visual outcome, suggesting trauma extent is also a key factor.
Conclusions:
- Pediatric endophthalmitis is frequently associated with trauma and often caused by Gram-positive bacteria.
- Early diagnosis and empirical antibiotic treatment, even before culture confirmation, are vital.
- Visual outcomes are influenced by both the endophthalmitis and the severity of associated trauma.
Abstract:
A study of 22 consecutive cases of suspected endophthalmitis in children disclosed that 68% (15/22) were male with a mean age of 7.4 years. In contrast to adult populations, 86% (19/22) followed trauma in this series. Cultures were performed in 18 cases yielding positive results in 8 cases. Anterior chamber paracentesis was positive in 6/10 attempts, vitreous cultures in 1/4, and wound cultures in 2/7. Gram-positive organisms were recovered in 75% (6/8) of the cultures, stressing the importance of coverage for these organisms before culture results are known. Although cultures should be obtained as soon as possible, the initiation of antibiotics beforehand should not deter one from obtaining cultures as 75% (6/8) of patients with positive cultures had preculture antibiotics. Fourteen patients were diagnosed within 48 hours of the precipitating event, and all of these cases followed trauma. Three of 7 patients with positive cultures and 1 of 10 patients with negative cultures had final visual acuities of 20/200 or better. The lack of correlation between a positive culture and a poor visual outcome suggests that the final visual acuity depends not only on the endophthalmitis, but also on the extent of trauma.