Susceptibility of bacterial isolates to vancomycin and ceftazidime from patients with endophthalmitis: Is there a need to change the empirical therapy in suspected bacterial endophthalmitis?
To review the susceptibility of bacterial isolates to ceftazidime and vancomycin isolated from patients with endophthalmitis. Microbiology records of patients with endophthalmitis between June 2010 and May 2013 were reviewed. Vitreous and AC fluids obtained from patients with endophthalmitis were subjected to direct microscopy examination and culture. Antibiotic susceptibility of the isolates was performed by Kirby Bauer disk diffusion method. Resistant to ceftazidime in Gram negative bacteria (GNB) by disk diffusion method is confirmed by minimum inhibitory concentration using E test. Culture was positive for bacteria/Fungi in 224/356 patients (62.9 %). Out of 224 patients, 191 (85.2 %) patients showed bacterial growth and 33 (14.0 %) showed fungal growth. Mixed bacterial infection was seen in five patients. Among the GNB, 23/123 (18 %) of the isolates were resistant to ceftazidime, and all the Gram positive bacteria 73/73 (100 %) were susceptible to vancomycin. Sixteen of 123 (13 %) GNB were resistant to amikacin. Although there is an increase in resistance to ceftazidime compared to amikacin in GNB, amikacin intravitreal injection is associated with macular toxicity and no single antibiotic has full coverage for all GNB. Combination of vancomycin and ceftazidime empiric therapy can be continued in patients with suspected endophthalmitis and treatment is modified based on clinical response and susceptibility results.
GHR Micro Diagnostics, Dwarakapuri Colony, Panjagutta, Hyderabad, 500082, India. ashokreddyg999@yahoo.com.
Ashok Kumar
AK
Reddy
NeoRetina Eye Care Institute, Hyderabad, India.
Raja Rami
RR
Reddy
Maxivision Eye Hospital, Hyderabad, India.
Muralidhar Rao
MR
Paruvelli
NeoRetina Eye Care Institute, Hyderabad, India.
Srinivas
S
Ambatipudi
NeoRetina Eye Care Institute, Hyderabad, India.
Alka
A
Rani
Sarojini Devi Eye Hospital, Hyderabad, India.
Sikander A K
SA
Lodhi
Sarojini Devi Eye Hospital, Hyderabad, India.
Juturi Maruthi Lokabhi
JM
Reddy
Medivision Eye and Health Care Centre, Hyderabad, India.
K Ramakanth
KR
Reddy
Aravind Eye Hospital, Hyderabad, India.
Niraj
N
Pandey
Vasan Eye Care, Hyderabad, India.
Rituraj
R
Videkar
Vasan Eye Care, Hyderabad, India.
Manish Kumar
MK
Sinha
Centre for Sight, Hyderabad, India.
Ajit Babu
AB
Majji
Maxivision Eye Hospital, Hyderabad, India.
Nilanjana
N
Deb-Jorder
Agarwal Eye Hospital, Hyderabad, India.
Atul Kumar
AK
Sahu
Krishna Institute of Medical Sciences, Hyderabad, India.
Jyostna
J
Myneni
Swarup Eye Centre, Hyderabad, India.
Anina
A
Abraham
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D002442:Ceftazidime / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005500:Follow-Up Studies; D006801:Humans; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use*; D014822:Vitreous Body / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D002442:Ceftazidime
Amikacin; Ceftazidime; Endophthalmitis; Gram negative bacilli; Vancomycin