Endophthalmitis caused by proteus species: antibiotic sensitivities and visual acuity outcomes.
OBJECTIVE
The purpose of this study was to report the clinical presentation, causative organisms, antibiotic sensitivities, management, and visual acuity outcomes in patients with endophthalmitis caused by Proteus species at a university teaching hospital over a 24-year period.


METHODS
This was a retrospective consecutive case series. The Bascom Palmer Eye Institute Microbiology Laboratory database was reviewed to identify all patients with intraocular cultures positive for Proteus species between 1983 and 2007. Clinical records were reviewed to ascertain the clinical presentation, management, and visual acuity outcomes.


RESULTS
In the 13 patients identified, all cases followed intraocular surgery, and 1 was associated with a recurrent corneal ulcer. Of the 1,751 organisms isolated from intraocular culture during the study period, 244 were Gram negative. Proteus species represented 5.3% of gram-negative organisms and <1% of the total isolates identified. Endophthalmitis developed 2 days to 14 days postoperatively (median, 3.5 days), and patients were observed 1 month to 61 months after presentation (median, 17 months). Presenting vision ranged from light perception to 20/200. Ten patients had positive cultures for Proteus mirabilis, and three patients had a growth of Proteus morganii. Four patients (31%) were infected with >1 organism. All Proteus isolates were sensitive to the antibiotics clinically administered, including cefazolin, ceftazidime, gentamicin, and the fluoroquinolones. Five patients (38%) initially received intravitreal injections of antibiotics alone, 1 received an anterior chamber washout in combination with intravitreal injections, and 7 patients (54%) received pars plana vitrectomy in combination with intravitreal injections. Two of the patients (15%) who received vitrectomies had either an intraocular lens or retained nuclear fragments removed. Six patients (46%) received additional antibiotic injections during the clinical course, and 6 patients (46%) underwent additional surgical procedures. Final visual acuity was better than light perception in 5 patients (38%) and was light perception or no light perception in 8 patients (62%). Only 4 patients (31%) had a final vision acuity > or =5/200.


CONCLUSIONS
Despite prompt treatment with appropriate antibiotics, the clinical outcome for Proteus species endophthalmitis is often poor.
Leng
Theodore
T
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Flynn
Harry W
HW
Miller
Darlene
D
Murray
Timothy G
TG
Smiddy
William E
WE
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D009877:Endophthalmitis / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011511:Proteus / Q000187:drug effects*; D011512:Proteus Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D000900:Anti-Bacterial Agents