Local patterns of endophthalmitis at an Australian tertiary referral centre: an 11-year retrospective case series

This is the authors' abstract. We don't add key points for this paper.

Background This study aimed to identify causative organisms of endophthalmitis, their resistance and susceptibility profiles, treatment and visual outcomes at Liverpool Hospital, Sydney, Australia over an 11-year period, and to compare these results with Australian literature. Methods Retrospective chart review of endophthalmitis cases from Jan 2010 to Apr 2021 at a tertiary referral hospital. Cases were identified through ICD-10 codes. Type of endophthalmitis, organism, antibiotic susceptibilities, treatment, and visual outcomes were documented. Results Of 54 eyes, 27 had exogenous endophthalmitis and 27 had endogenous endophthalmitis. Follow-up was defined at 3–6 months. The proportion of eyes with best-corrected visual acuity (BCVA) poorer than 6/60 at presentation was higher than at follow-up (78.8% vs. 34.1%, p < 0.001). Median logMAR BCVA at presentation was poorer than at follow-up overall (2.20 vs. 0.78, p = 0.007), and in the endogenous group (1.80 vs. 0.30, p = 0.01), but not in the exogenous group. Twenty cases had a vitrectomy, with median time-to-vitrectomy at 5.5 days. These patients had significant improvement in initial logMAR BCVA compared with follow-up (2.00 vs. 0.48, p = 0.003). Better initial BCVA predicted a better final BCVA ( p < 0.001). The commonest organism was Staphylococcus aureus, 40% being MRSA. Among tested bacterial isolates, no resistance to vancomycin or ceftazidime was detected. The most common Gram-negative causative organism was Klebsiella pneumoniae , accounting for 83% of cases of hepatic abscesses in Asian patients. Conclusion Gram-positive endophthalmitis was the most common. Compared to other Australian centres, there is a higher rate of endogenous endophthalmitis. There was an increased proportion of Klebsiella pneumoniae endophthalmitis associated with liver abscess. No resistance to vancomycin or ceftazidime was detected among tested isolates, although susceptibility testing was limited. Better presenting BCVA predicted a better final BCVA.