title: A case-control study of post-traumatic endophthalmitis at a Spanish hospital.
abstract: Our aim was to identify the potential risk factors for developing post-traumatic endophthalmitis (PTE) and the possible measures of prevention. Retrospective case-control study, with 15 cases of PTE and 2 matched controls. We reviewed the medical records of the cases and their respective controls during the period 1996-2008 at a Spanish Hospital. We collected demographic data and information about the type of trauma, the potential risk factors, comorbidities, microbial isolations, antimicrobial susceptibility, administered treatments, and the visual outcome. The independent predictor factors identified for PTE were intraocular foreign body (IOFB) (OR 5.48; CI 95 % 1.05-28.7), dirty wound (OR 4.91; CI 95 % 0.96-25.3), and wound closure delays of 24 h or more (OR 5.48; CI 95 % 1.05-28.7). The probability of endophthalmitis in patients without these risk factors was 5.9 %, but ascended to 65.3 % and 90.3 %, in those patients with two and three risk factors, respectively. Infected patients presented a complication rate of 80 %, with an evisceration rate of 53 %; both were significantly associated with infection. The visual outcome was poor and related to the presence of IOFB and virulent microorganisms (Bacillus sp., filamentous fungus), visual acuity at presentation, and retinal detachment. Patients who presented an IOFB, dirty wound, and delayed wound closure were 15 times more likely to develop infection, and when infected, patients fared much worse than those non-infected. We thus recommend aggressive prophylactic measures in patients with these risk factors, adding antifungal prophylaxis when the injury is contaminated with vegetable matter.
authors.affiliation: Department of Microbiology, Hospital General La Mancha Centro, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain. marian_asencio@yahoo.es.
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Asencio
authors.affiliation: Department of Microbiology, Hospital General La Mancha Centro, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Huertas
authors.affiliation: Department of Microbiology, Hospital General La Mancha Centro, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Carranza
authors.affiliation: Support Research Unit, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Tenias
authors.affiliation: Department of Ophthalmology, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Celis
authors.affiliation: Department of Ophthalmology, La Mancha Centro General Hospital, Avenida Constitución 3, 13600, Alcazar de San Juan, Ciudad Real, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gonzalez-del Valle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D009877:Endophthalmitis / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D005129:Eye Foreign Bodies / Q000150:complications; D015817:Eye Infections / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D015807:Eye Injuries, Penetrating / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial prophylaxis; Intraocular foreign body; Post-traumatic endophthalmitis; Risk factors; Visual outcome