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      Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

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          Abstract

          Purpose

          To analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients.

          Methods

          Patients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively.

          Results

          A total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0–3 years, 16.3% in 4–12 years, and 6.3% in 13–17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%.

          Conclusion

          Trauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.

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          Most cited references33

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          Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction.

          J. Wong (2000)
          To report 32 eyes of 27 patients with endogenous bacterial endophthalmitis seen over a 4 year period. Features and outcomes of this condition in the current series and the cases reported in the literature from 1986-1998 were reviewed. Retrospective noncomparative case series. All patients with this condition seen at the three participating general hospitals were included. A review of the systemic and ocular characteristics, therapeutic methods, and final outcomes in patients afflicted with this condition. Features studied included patients' demographic characteristics, microbiology, source of infection, ocular features, therapeutic interventions, final visual and anatomic outcomes. Nineteen (70%) of the 27 incriminating organisms in this case series were gram negative microbes, with Klebsiella pneumoniae infections alone being responsible in 16 (60%) cases. Hepatobiliary tract infection was the source of bacteremia in 13 (48%) patients. Only nine (28%) eyes obtained good final visual acuity (20/120 or better), and two eyes were enucleated/eviscerated. A literature review of 209 patients with endogenous endophthalmitis over a 12 year period showed a similar increase in the frequency of gram negative microbes as the responsible organism, especially among the East Asian population. Overall, 22% had bilateral involvement; two thirds of patients had predisposing factor(s) or underlying illness(es), and diabetes mellitus was present in 46%. Thirty-four percent of all eyes obtained counting finger or better final vision, and 16% had their eyes eviscerated or enucleated. Infections with virulent organisms (gram negative rods, Serratia, Bacillus) usually denoted a grave visual prognosis; however, a media that was not opaque on presentation was usually associated with a good prognosis. Metastatic ocular infection is not uncommon despite the availability of modern antibiotic therapy. Among the East Asian population, the patient at highest risk is a diabetic patient with Klebsiella pneumoniae hepatobiliary infection. In contrast, in the Caucasian population, this condition occurs in predisposed patients with gram-positive bacteremia arising from endocarditis or skin/joint infections. The final visual outcome in patients with endogenous bacterial endophthalmitis in the recent 12 years has not differed significantly from five decades ago.
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            Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review.

            To identify the spectrum and susceptibility pattern of pathogens responsible for culture-positive endophthalmitis referred to a single institution and investigate possible trends in both pathogens and antibiotic sensitivities over the past 25 years.
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              Endophthalmitis isolates and antibiotic sensitivities: a 6-year review of culture-proven cases.

              To investigate the spectrum of organisms causing culture-proven endophthalmitis and their sensitivities to commonly used antimicrobial agents. Retrospective, noncomparative, consecutive case series. Medical records were reviewed of all patients with culture-proven endophthalmitis at a single institution between January 1, 1996, and December 31, 2001. Endophthalmitis categories included postoperative, posttraumatic, endogenous, and miscellaneous (for example, keratitis). The outcome measures included intravitreal isolates identified, antibiotic sensitivities, and category of endophthalmitis. In all, 313 organisms were isolated from 278 patients during the study interval. The most common organisms identified were Staphylococcus epidermidis in 27.8% (87/313), Streptococcus viridans group in 12.8% (40/313), other coagulase-negative staphylococci in 9.3% (29/313), Staphylococcus aureus in 7.7% (24/313), and Propionibacterium acnes in 7.0% (22/313). Overall, 246 of 313 (78.5%) isolates were gram-positive organisms, 37 (11.8%) were gram-negative organisms, and 27 (8.6%) were fungi. For gram-positive organisms, sensitivities were the following: vancomycin 100%, gentamicin 78.4%, ciprofloxacin 68.3%, ceftazidime 63.6%, and cefazolin 66.8%. For gram-negative organisms, sensitivities were the following: ciprofloxacin 94.2%, amikacin 80.9%, ceftazidime 80.0%, and gentamicin 75.0%. Fungal isolates were Candida species (9/313), Aspergillus species (9/313), and other molds (9/313). Among the endophthalmitis categories, the most frequent organisms were the following: (1) acute-onset postoperative: S epidermidis, 46.9%; (2) delayed-onset postoperative: S epidermidis, 22.7%; (3) delayed-onset bleb-associated: fastidious gram-negative rods, 20.4%; (4) posttraumatic: S epidermidis, 20.8%; (5) endogenous: Aspergillus species, 20.8%; and (6) miscellaneous: molds (other), 36.4%. In considering antibiotic treatment of endophthalmitis, it is important to recognize that no single antibiotic provided coverage for all of the microbes isolated from eyes with endophthalmitis. Combination therapy is recommended as the initial empiric treatment of suspected bacterial endophthalmitis. Appropriate history and characteristic clinical features may justify the use of initial antifungal agents. Knowledge of the most frequent causative organisms in various categories will help direct appropriate initial therapy.
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                Author and article information

                Contributors
                duanfangg@126.com
                linxiaof@mail.sysu.edu.cn
                Journal
                Graefes Arch Clin Exp Ophthalmol
                Graefes Arch Clin Exp Ophthalmol
                Graefe's Archive for Clinical and Experimental Ophthalmology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0721-832X
                1435-702X
                18 August 2020
                18 August 2020
                2021
                : 259
                : 1
                : 197-204
                Affiliations
                GRID grid.12981.33, ISNI 0000 0001 2360 039X, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, , Sun Yat-sen University, ; 54 South Xianlie Road, Guangzhou, 510060 China
                Author information
                http://orcid.org/0000-0002-4596-2196
                Article
                4866
                10.1007/s00417-020-04866-7
                7790763
                32808064
                cef1bd25-cdce-4ca9-baed-834160b50174
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 27 November 2019
                : 21 July 2020
                : 27 July 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100010909, Young Scientists Fund;
                Award ID: 81900851
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100003453, Natural Science Foundation of Guangdong Province;
                Award ID: 2018A030313585
                Award Recipient :
                Funded by: Fundamental Research Funds of the State Key Laboratory of Ophthalmology
                Award ID: 30306020240020130
                Award ID: 3030902113030
                Award Recipient :
                Categories
                Pediatrics
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2021

                Ophthalmology & Optometry
                child,endophthalmitis,microbiological profile,antibiotics,epidemiology
                Ophthalmology & Optometry
                child, endophthalmitis, microbiological profile, antibiotics, epidemiology

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