Clinical presentations, risk factors and outcomes of ceftazidime-resistant Gram-negative endophthalmitis.
BACKGROUND
To describe the clinical features and outcomes of patients diagnosed with ceftazidime-resistant Gram-negative endophthalmitis and the role of intravitreal imipenem in these cases.


METHODS
Retrospective consecutive interventional case series at a tertiary eye care centre in South India.


METHODS
Consecutive cases of ceftazidime-resistant Gram-negative endophthalmitis from April 2010 to December 2014. Fifty-six cases diagnosed during this time period were included.


METHODS
All cases were managed with vitreous biopsy/vitrectomy, microscopy and undiluted vitreous culture, antimicrobial susceptibility of bacterial isolates and received intravitreal antibiotics.


METHODS
Anatomic and visual outcome of these cases, antimicrobial susceptibility pattern of intravitreal imipenem and outcome of cases injected with it.


RESULTS
Commonest presentation was acute endophthalmitis following cataract surgery (27 eyes, 48.21%). Pseudomonas aeruginosa was isolated in 33 eyes (58.93%; 95% CI 46.05-71.81%). Nineteen eyes (34%; 95% CI 21.59-46.41%) developed phthisis; 14 eyes (25%; 95% CI 13.66-36.34%) had vision <20/200; 17 eyes (30.35%; 95% CI 18.31-42.39%) eyes had an ambulatory vision >20/200 (logMAR 1); 6 eyes (10.71%; 95% CI 2.61-18.81%) had a reading vision >20/40 (logMAR 0.3). Trend was towards better anatomic (72.73% vs. 40%) (P = 0.05) and visual improvement in the imipenem group (logMAR 3.94 + 0.21 to 2.43 + 1.4; P = 0.002), as compared with non-imipenem group (logMAR 2.99 + 1.3 to 2.55 + 1.4; P = 0.13).


CONCLUSIONS
Outcome of ceftazidime-resistant Gram-negative endophthalmitis is poor. P. aeruginosa is the commonest isolated organism. All cases were sensitive to imipenem. There was a trend towards better anatomic outcome in imipenem-treated eyes.
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Vivek Pravin
VP
Dave
Vitreo Retina and uveitis service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India.
Avinash
A
Pathengay
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Kumar
K
Nishant
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Rajeev R
RR
Pappuru
Jhaveri Microbiology Center, Brien Holden Eye Research Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Savitri
S
Sharma
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Pranjali
P
Sharma
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Raja
R
Narayanan
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Subhadra
S
Jalali
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Annie
A
Mathai
Smt. Kanuri Santhamma Center for vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Taraprasad
T
Das
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D009877:Endophthalmitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents; D015378:Imipenem; D002442:Ceftazidime
Gram-negative; ceftazidime resistance; endophthalmitis; imipenem; intravitreal injection