title: Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility: literature review and options for treatment.
abstract: BACKGROUND
  Endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or resistance is an important clinical issue worldwide.
  
  
  OBJECTIVE
  To review the published literature on endophthalmitis caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance.
  
  
  METHODS
  The data were analysed from a PubMed search of endophthalmitis cases caused by Gram-positive organisms with reported reduced vancomycin susceptibility and/or vancomycin resistance from 1990 to 2015.
  
  
  RESULTS
  From 18 publications identified, a total of 27 endophthalmitis cases caused by Gram-positive organisms with reduced vancomycin susceptibility and/or vancomycin resistance were identified. The aetiologies of endophthalmitis were exogenous in 19/27 cases (11 post-cataract surgery, 2 post-penetrating keratoplasty, 1 post-glaucoma surgery, 4 post-open globe injury, 1 post-intravitreal injection of ranibizumab), and endogenous in 4/24 cases; no details were available about the four remaining patients. The causative organisms included Enterococcus species (7/27), coagulase-negative staphylococci (4/27), Staphylococcus aureus (4/27), Bacillus species (4/27), Streptococcus species (3/27), Leuconostoc species (3/27), Staphylococcus hominis (1/27), and unidentified Gram-positive cocci (1/27). Visual acuity of 20/400 or better at the final follow-up was recorded in 10/26 patients (38.5%; data were not available for one patient). Treatment options include fluoroquinolones, penicillin, cephalosporins, tetracyclines, and oxazolidinones.
  
  
  CONCLUSIONS
  In the current study, visual acuity outcomes were generally poor. Enterococcus and Staphylococcus species were the most common organisms reported and postoperative endophthalmitis after cataract surgery was the most common clinical setting.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Nidhi
authors.identifier: http://orcid.org/0000-0002-7815-0119
authors.initials: N
authors.lastname: Relhan
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Thomas A
authors.identifier: http://orcid.org/0000-0003-2199-9047
authors.initials: TA
authors.lastname: Albini
authors.affiliation: Retina and Uveitis Department, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andha Pradesh, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Pathengay
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Ajay E
authors.identifier: http://orcid.org/0000-0002-2824-3245
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Darlene
authors.identifier: http://orcid.org/0000-0002-4756-2030
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D009877:Endophthalmitis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D013754:Tetracyclines / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance / Q000187:drug effects*; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D023303:Oxazolidinones; D010406:Penicillins; D013754:Tetracyclines; D014640:Vancomycin
keywords: Eye (Globe); Infection; Microbiology; Retina; Vitreous