title: Persistently Vitreous Culture-Positive Exogenous Bacterial Endophthalmitis.
abstract: To report the clinical settings, bacterial isolates, antibiotic sensitivities, and visual acuity outcomes of patients with persistently positive vitreous cultures after intravitreal antibiotics.
  
  
  
  Consecutive, noncomparative case series.
  
  
  
  setting: Tertiary care center.
  
  
  
  Thirty-six eyes of 36 patients with exogenous endophthalmitis with the same bacterial organism identified on at least 2 consecutive vitreous cultures from 1981 to 2015.
  
  
  
  Vitreous cultures with intravitreal injections of antibiotics and pars plana vitrectomies with intravitreal antibiotics.
  
  
  
  Bacterial isolates, antibiotic sensitivities, visual outcomes.
  
  
  
  Thirty-six eyes of 36 patients met the study criteria. The mean follow-up was 26.5 months. The most common clinical settings were after cataract extraction (18/36, 50%) and glaucoma surgery (11/36, 31%). The mean initial visual acuity was 2.16 ± 0.77 logMAR (Snellen equivalent ≈20/2900), and there was no statistically significant change at the final evaluation (2.08 ± 0.97 logMAR, ≈20/1900, P = .72). The most common bacteria were Staphylococcus (11/36, 31%) and Streptococcus (9/36, 25%). Gram-positive bacteria were sensitive to vancomycin (27/27, 100%); gram-negative bacteria were sensitive to amikacin (5/5, 100%). The antibiotic sensitivities were the same on repeat cultures in 34 of 36 patients (94%). The initial treatment was a vitreous culture and intravitreal injection of antibiotics in 28 of 36 patients (78%). The vision at the last follow-up was 20/200 or better in 12 patients (33%) and no light perception in 11 of 36 patients (31%).
  
  
  
  The most commonly identified organisms were gram-positive bacteria. There was good concordance in the antibiotic sensitivities between initial and subsequent cultures. Patients with persistently vitreous culture-positive endophthalmitis had poor visual outcomes.
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Ella H
authors.initials: EH
authors.lastname: Leung
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Ajay E
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida. Electronic address: hflynn@med.miami.edu.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005901:Glaucoma / Q000601:surgery; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011183:Postoperative Complications; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000583:Amikacin