title: Clinical and microbiologic review of culture-proven endophthalmitis caused by multidrug-resistant bacteria in patients seen at a tertiary eye care center in southern India.
abstract: OBJECTIVE
  To determine the type of bacteria and the visual outcome of culture-proven multidrug-resistant bacterial endophthalmitis in patients at a tertiary eye care center in southern India.
  
  
  METHODS
  This is a retrospective case series in which clinical and microbiologic records of culture-proven bacterial endophthalmitis between January 2000 and December 2007 were reviewed. Multidrug resistance was defined as resistance to two or more different groups of typically susceptible classes of antibiotics.
  
  
  RESULTS
  Of 807 patients, vitreous from 42 patients (5.2%) yielded multidrug-resistant bacteria in culture. Thirty-two (71%) of these patients had a poor visual outcome (31.6% in non-multidrug-resistant group). Multidrug resistance was more common in gram-negative bacteria (33; 78.6%) compared with gram-positive bacteria (9; 21.4%). Pseudomonas spp. (24 isolates) were the most common isolated bacteria. Fifteen (45%) of the 33 gram-negative isolates were resistant to ceftazidime, 18 (54.5%) were resistant to amikacin, and 11 (33.3%) were resistant to both amikacin and ceftazidime. Five (55.56%) of the 9 gram-positive isolates were resistant to vancomycin.
  
  
  CONCLUSIONS
  Gram-negative bacteria, chiefly Pseudomonas, are the most common multidrug-resistant organisms, and the outcome is usually poor. Emergence of multidrug-resistant bacteria is a matter of concern. A new alternative group of drugs may be considered for the management of these isolated cases.
authors.affiliation: Retina Vitreous Services, L. V. Prasad Eye Institute, GMR Varalakshmi Campus, Vishakapatnam, Andhra Pradesh, India. avinash@lvpei.org
authors.forename: Avinash
authors.initials: A
authors.lastname: Pathengay
authors.forename: Mayur R
authors.initials: MR
authors.lastname: Moreker
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puthussery
authors.forename: Srinivas
authors.initials: S
authors.lastname: Ambatipudi
authors.forename: Subhadra
authors.initials: S
authors.lastname: Jalali
authors.forename: Ajit B
authors.initials: AB
authors.lastname: Majji
authors.forename: Annie
authors.initials: A
authors.lastname: Mathai
authors.forename: Nazimul
authors.initials: N
authors.lastname: Husssain
authors.forename: Vivek
authors.initials: V
authors.lastname: Dave
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
authors.forename: Taraprasad
authors.initials: T
authors.lastname: Das
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001431:Bacteriological Techniques; D024901:Drug Resistance, Multiple, Bacterial; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007194:India; D058449:Intravitreal Injections; D008826:Microbial Sensitivity Tests; D009885:Ophthalmology / Q000458:organization & administration; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D000900:Anti-Bacterial Agents