Acute endophthalmitis in eyes treated prophylactically with gatifloxacin and moxifloxacin.
OBJECTIVE
To study the use of prophylactic fourth-generation fluoroquinolone antibiotics, gatifloxacin and moxifloxacin, and bacterial sensitivity in cases of acute postoperative endophthalmitis following cataract surgery.


METHODS
Retrospective, consecutive, observational case series.


METHODS
Forty-two eyes of 42 patients with acute endophthalmitis occurring within six weeks after cataract surgery were identified. All patients were seen in a referral vitreoretinal practice over a two-year time interval. The number of patients using prophylactic gatifloxacin or moxifloxacin and results of bacterial culture and sensitivity to all fluoroquinolone antibiotics were recorded.


RESULTS
Thirty-one of 42 eyes (74%) were treated with perioperative gatifloxacin or moxifloxacin and 24 eyes (57%) were continuously taking one of these antibiotics at the time of diagnosis. Nineteen eyes (45%) had a positive bacterial culture. The most frequent organism isolated was coagulase-negative Staphylococcus. Sensitivities were performed for 14 gram-positive organisms, and sensitivities to ciprofloxacin (50%), ofloxacin (44%), levofloxacin (46%), gatifloxacin (38%), and moxifloxacin (38%) were noted. Five organisms were resistant to gatifloxacin and moxifloxacin with a minimum inhibitory concentration of 8 microg/ml. All gram-positive organisms were sensitive to vancomycin. Median visual acuity improved from hand motions to 20/40 at last follow-up.


CONCLUSIONS
Acute endophthalmitis can develop after cataract surgery despite the prophylactic use of fourth-generation fluoroquinolone antibiotics. Gram-positive organisms causing acute endophthalmitis are frequently resistant to all fluoroquinolones, including a significant number of cases resistant to gatifloxacin and moxifloxacin.
Deramo
Vincent A
VA
Department of Ophthalmology, North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York, USA. vderamo@optonline.net
Lai
James C
JC
Fastenberg
David M
DM
Udell
Ira J
IJ
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001372:Aza Compounds / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction; D024881:Drug Resistance, Bacterial; D009877:Endophthalmitis / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D000077734:Gatifloxacin; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D000077266:Moxifloxacin; D011183:Postoperative Complications; D011804:Quinolines / Q000627:therapeutic use*; D012189:Retrospective Studies
D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077734:Gatifloxacin; D000077266:Moxifloxacin