Humans ; Endophthalmitis/microbiology* ; Eye Infections, Bacterial/microbiology* ; Anti-Bacterial Agents/therapeutic use* ; Retrospective Studies

BACKGROUNDPediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China.

METHODSIt is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation.

RESULTSA total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients.

CONCLUSIONSPenetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly seen in endogenous endophthalmitis. In this research, in spite of aggressive management with antibiotics and vitrectomy, the visual prognosis was found to be generally poor.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; China ; Endophthalmitis ; drug therapy ; microbiology ; pathology ; Eye Infections, Fungal ; drug therapy ; microbiology ; pathology ; Eye Injuries, Penetrating ; microbiology ; Female ; Fusarium ; pathogenicity ; Humans ; Infant ; Male ; Retina ; microbiology ; Retrospective Studies ; Staphylococcus ; pathogenicity ; Streptococcus ; pathogenicity ; Vitrectomy

BACKGROUND/AIMS: Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. METHODS: Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non-LAEE. RESULTS: The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. CONCLUSIONS: PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision.
Aged ; Anti-Bacterial Agents/administration & dosage ; Chi-Square Distribution ; Early Diagnosis ; Endophthalmitis/diagnosis/*epidemiology/microbiology/therapy ; Female ; Humans ; Intravitreal Injections ; Liver Abscess, Pyogenic/diagnosis/*epidemiology/microbiology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Visual Acuity ; Vitrectomy

This study analyzed the recent causes, prognosis, and treatment strategies for fungal endophthalmitis. A retrospective review of patients who were diagnosed with fungal endophthalmitis at our center was conducted. The fungal organisms isolated from each patient and the visual prognosis according to the route of infection and treatment method were analyzed. A total of 40 eyes from 30 patients with fungal endophthalmitis were included in this study. Candida species were the most common causative organisms in 35 of 40 eyes. Endogenous and exogenous endophthalmitis were observed in 33 and 7 eyes, respectively. Pre- and post-treatment best-corrected visual acuity (BCVA) was not significantly different between endogenous endophthalmitis and exogenous endophthalmitis. The 40 eyes were treated using the following modalities: intravitreal antifungal agent injection with intravenous antifungal agent (16 eyes), vitrectomy with intravenous antifungal agent (14 eyes), intravenous antifungal agent alone (9 eyes), and evisceration (1 eye). Post-treatment BCVA only significantly improved after treatment in the vitrectomy group. Candida species were the most common cause of fungal endophthalmitis, irrespective of the route of infection. The visual prognosis of fungal endophthalmitis was generally poor. In conclusion, if the general condition of the patient tolerates a surgical procedure, prompt vitrectomy and intravitreal injection of antifungal agents can improve visual acuity.
Antifungal Agents/*therapeutic use ; Aspergillus/isolation & purification ; Candida/*isolation & purification ; Endophthalmitis/*drug therapy/*microbiology/pathology/surgery ; Eye Infections, Fungal ; Fusarium/isolation & purification ; Humans ; Prognosis ; Republic of Korea ; Retrospective Studies ; Scedosporium/isolation & purification ; Tertiary Care Centers ; Visual Acuity ; *Vitrectomy

Aged, 80 and over ; Endophthalmitis ; ethnology ; microbiology ; Female ; Humans ; Sepsis ; complications ; microbiology ; Streptococcal Infections ; complications ; Streptococcus agalactiae ; pathogenicity

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.
Aged ; Anti-Bacterial Agents/therapeutic use ; Endophthalmitis/drug therapy/*microbiology ; Escherichia coli/*isolation & purification ; Female ; Humans ; Phacoemulsification ; Postoperative Complications/diagnosis/*microbiology ; Visual Acuity ; beta-Lactamases

A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
Anti-Bacterial Agents/administration & dosage ; Cataract Extraction/adverse effects ; Citrobacter koseri/*isolation & purification ; Diagnosis, Differential ; Endophthalmitis/diagnosis/*microbiology/therapy ; Enterobacteriaceae Infections/diagnosis/*microbiology/therapy ; Eye Infections, Bacterial/diagnosis/*microbiology/therapy ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Lens Implantation, Intraocular/*adverse effects ; Male ; Microscopy, Acoustic ; Middle Aged ; Surgical Wound Infection/diagnosis/*microbiology/therapy ; Sutures/adverse effects/microbiology ; Visual Acuity ; Vitrectomy ; Vitreous Body/*microbiology

PURPOSE: To identify the clinical features and outcomes of endogenous endophthalmitis in Korea. MATERIALS AND METHODS: We reviewed 18 patients with endogenous endophthalmitis at 2 Korean hospitals, treated over a 14 year period between January 1993 and December 2006. RESULTS: The comorbidities observed in these cases were diabetes mellitus and liver cirrhosis. The most common pathogens, which were found in 7 patients each (38.9%), were Klebsiella pneumonia and Pseudomonas aeruginosa. All patients were treated with systemic antibiotics and fortified topical antibiotics. A surgical approach including vitrectomy was performed in 9 cases (50.0%). The prognosis was generally poor, and visual acuity improved slightly in 6 patients (33.3%). CONCLUSION: In this study, diabetes mellitus and Klebsiella pneumonia showed a close relationship with endogenous endophthalmitis, respectively. Endogenous endophthalmitis is a serious risk to sight and careful attention to establishing the diagnosis and management may decrease the ocular morbidity.
Aged ; Diabetes Complications/*epidemiology/microbiology ; Endophthalmitis/complications/*epidemiology/microbiology ; Female ; Humans ; Incidence ; Klebsiella pneumoniae/isolation & purification ; Liver Cirrhosis/*complications/epidemiology/microbiology ; Male ; Middle Aged ; Pseudomonas aeruginosa/isolation & purification ; Republic of Korea/epidemiology ; Retrospective Studies

We here in report a case of bilateral endogenous endophthalmitis caused by Pantoea agglomerans (P. agglomerans) in a patient who had interstitial lung disease and was treated with oral corticosteroids. A 72-year-old man presented with decreased visual acuity in both eyes nine days after he received oral corticosteroids. He had marked uveitis, cataracts, and vitreous opacities. Cultures were taken of blood, aqueous humor, and vitreous. We initially suspected a fungal etiology and treated him with antifungal drugs; however, the intraocular disease progressed without improvement. Vitreous culture was positive for P. agglomerans. The patient underwent pars plana vitrectomy with cataract surgery bilaterally, followed by a 2-week course of antibiotics. The final visual acuity was 20/25 in the right eye and 20/200 in the left eye. This is the first report of bilateral endogenous endophthalmitis caused by P. agglomerans in Korea; it is also the first case reported outside of the United States.
Aged ; Anti-Bacterial Agents/therapeutic use ; Endophthalmitis/complications/*microbiology/therapy ; Enterobacteriaceae Infections/complications/*microbiology/therapy ; Eye Infections, Bacterial/complications/*microbiology/therapy ; Follow-Up Studies ; Humans ; Lung Diseases, Interstitial/*complications ; Male ; Pantoea/*isolation & purification ; Visual Acuity ; Vitrectomy

A 64-year-old woman was referred to our clinic for the treatment of chronic uveitis in her left eye, which had started two weeks after an uncomplicated cataract extraction. She was treated with topical steroids with an initially good response, yet she subsequently developed severe inflammation and plaque-like material around the intraocular lens, despite continuous steroid therapy. She underwent pars plana vitrectomy, smear and culture of the aqueous and vitreous fluids, and intravitreal antibiotic injection under the impression of Propionibacterium acne (P. acne) endophthalmitis. As a result of the smear and culture of the vitreous fluid identified as an Acremonium species, she was treated with intravenous amphotericin B injections for five days, followed by oral voriconazole administration. During the post-operative 18-month follow-up, she was stable without significant relapse of uveitis. In this case, the best correction of visual acuity was an improvement from 20/40 to 20/20.
Acremonium/*isolation & purification ; Antifungal Agents/therapeutic use ; *Cataract Extraction ; Endophthalmitis/drug therapy/*microbiology ; Eye Infections, Fungal/drug therapy/*microbiology ; Female ; Humans ; Middle Aged