title: Endophthalmitis caused by Enterococcus faecalis: clinical features, antibiotic sensitivities, and outcomes.
abstract: OBJECTIVE
  To report the clinical features, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  A consecutive case series of patients with culture-positive endophthalmitis caused by E. faecalis between January 1, 2002, and December 31, 2012, at an academic referral center.
  
  
  RESULTS
  Of 14 patients identified, clinical settings included bleb association (n = 8), occurrence after cataract surgery (n = 4), and occurrence after penetrating keratoplasty (n = 2). All isolates were vancomycin sensitive. When comparing isolates in the current study with isolates from 1990 through 2001, the minimal inhibitory concentration required to inhibit 90% of isolates increased for ciprofloxacin (4 μg/mL from 1 μg/mL), erythromycin (256 μg/mL from 4 μg/mL), and penicillin (8 μg/mL from 4 μg/mL), indicating higher levels of resistance. The minimal inhibitory concentration required to inhibit 90% of isolates remained the same for vancomycin (2 μg/mL) and linezolid (2 μg/mL). Presenting visual acuity ranged from hand movements to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 12) and pars plana vitrectomy with intravitreal antibiotic injection (n = 2). Visual acuity outcomes were 20/400 or worse in 13 (93%) of 14 patients.
  
  
  CONCLUSIONS
  Although all isolates were sensitive to vancomycin and linezolid, higher minimal inhibitory concentration required to inhibit 90% of isolates in the current study, compared with isolates from 1990 through 2001, occurred with ciprofloxacin, erythromycin, and penicillin. Despite prompt treatment, most patients had poor outcomes.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. Electronic address: ajay.kuriyan@gmail.com.
authors.forename: Ajay E
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Jayanth
authors.initials: J
authors.lastname: Sridhar
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: William E
authors.initials: WE
authors.lastname: Smiddy
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Albini
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Forster
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Belin
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014822:Vitreous Body
chemical_list: D000900:Anti-Bacterial Agents
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