Clinical and microbiological characteristics of multidrug-resistant acute bacterial endophthalmitis after cataract surgery. Endophthalmitis Management Study Report # 8.

Report the clinico-microbiological characteristics of multidrug-resistant (MDR) acute post-cataract bacterial endophthalmitis. Consecutive 32 cases from a prospective multi-center study in India were analyzed for the clinical features, presenting visual acuity (PVA), and inflammation score (IS) before and three months after treatment. Absolute risk reduction (ARR) and number needed to treat (NNT) to avoid globe loss were calculated. The MDR incidence was 7.8% (32/ 410). It included 28 gram-negative bacilli (GNB, 87.5%) and 4 gram-positive cocci (GPC,12.5%). The PVA was light perception to hand motions in 93.9% (30/32) of patients. The mean IS was 17.34 + 3.96. The primary treatment was vitrectomy and intravitreal antibiotics (IVT); all patients required a second intervention - vitreous lavage and IVT (mean 2.43). GNBs were resistant to fluoroquinolones, aminoglycosides, and cephalosporins (39.3% each) and polymyxins (17.6%). Most amikacin- and ceftazidime-resistant (81.8%) GNBs were susceptible to colistin. Following treatment, 9.4% of eyes developed phthisis, 46.9% didn't improve vision, and 9.4% of eyes had > 20/40. The ARR was higher and the NNT was lower to avoid one globe loss with colistin than with other antibiotics. Colistin could be an alternative to treating multidrug-resistant post-cataract endophthalmitis caused by gram-negative bacilli in India.