Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population.
Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population.
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DOI：
10.1016/j.ophtha.2015.04.036
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发表时间：
2015-08
期刊：
影响因子：
13.7
通讯作者：
Schein OD
中科院分区：
文献类型：
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作者：
Gower EW;Keay LJ;Stare DE;Arora P;Cassard SD;Behrens A;Tielsch JM;Schein OD
眼内炎是白内障手术后一种罕见但威胁视力的感染。大约三分之一的眼睛在治疗后仍然失明。我们报告了美国以人口为基础的微生物调查和治疗模式数据，以及不良结果的风险因素。回顾性队列研究。2003年和2004年，5个州的医疗保险受益人在白内障手术后6周内出现眼内炎。我们使用医疗保险账单索赔确定了白内障手术后发生的眼内炎病例。我们联系了治疗医生，要求他们填写一份关于临床和微生物学数据的问卷，并提交相关病历。两名独立观察员审查了材料，以确认病例符合标准化定义。培养阳性结果、玻璃体切除情况、微生物谱和最终视力。总共有615例符合我们的病例定义。72%的患者初始视力为数指或更差。在502例已知培养结果的病例中，291例(58%)培养阳性。12%的人链球菌检测呈阳性。99%以上的病例玻璃体腔内注射万古霉素。行玻璃体切割术279例(45%)，其中初始视力优于光感者201例。各州的玻璃体切割率各不相同，加利福尼亚州的玻璃体切割率最高，密歇根州的玻璃体切割率最低(分别为56%和19%)。总体而言，43%的人视力达到20/40或更高。较差的初始视力(调整后的优势比[OR]，1.08；95%可信区间[CI]，每0.10个分辨率单位的最小角度对数为1.04~1.12)，确诊时的年龄较大(OR，1.22；95%CI，每5年增加一次，1.03~1.45)，以及更多的致病微生物是最终视力低下的重要预测因素。链球菌感染的患者最终视力差的可能性是凝固酶阴性葡萄球菌患者的10倍(调整后OR为11.28；95%CI为3.63-35.03)。玻璃体切除不能预测最终视力(调整后的OR为1.26；95%CI为0.78-2.04)。美国白内障手术后急性术后眼内炎的人群微生物学数据与先前的报道一致。玻璃体切割术的使用率高于眼内炎玻璃体切割术研究的推荐值，但没有证据表明益处增加。
Endophthalmitis is a rare but sight-threatening infection after cataract surgery. Roughly one third of eyes remain blind after treatment. We report United States population-based data on microbiological investigations and treatment patterns plus risk factors for poor outcomes. Retrospective cohort study. Medicare beneficiaries from 5 states in whom endophthalmitis developed within 6 weeks after cataract surgery in 2003 and 2004. We identified endophthalmitis cases occurring after cataract surgery using Medicare billing claims. We contacted treating physicians and requested they complete a questionnaire on clinical and microbiological data and submit relevant medical records. Two independent observers reviewed materials to confirm that cases met a standardized definition. Positive culture results, vitrectomy status, microbiology spectrum, and final visual acuity. In total, 615 cases met our case definition. Initial visual acuity was counting fingers or worse for 72%. Among 502 cases with known culture results, 291 (58%) had culture positive results. Twelve percent had positive results for streptococci. More than 99% of cases were treated with intravitreal vancomycin. Vitrectomy was performed in 279 cases (45%), including 201 cases with initial acuity better than light perception. Rates of vitrectomy varied across states, with California having the highest rate and Michigan having the lowest (56% and 19% of cases, respectively). Overall, 43% of individuals achieved visual acuity of 20/40 or better. Poor initial acuity (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04–1.12 per 0.10 logarithm of the minimum angle of resolution units), older age at diagnosis (OR, 1.22; 95% CI, 1.03–1.45 per 5-year increase), and more virulent organisms were important predictors of poor final visual acuity. Cases with streptococci infection were 10 times more likely to have poor final acuity than coagulase-negative staphylococci cases (adjusted OR, 11.28; 95% CI, 3.63–35.03). Vitrectomy was not predictive of final visual acuity (adjusted OR, 1.26; 95% CI, 0.78–2.04). Population-based data on the microbiology of acute postoperative endophthalmitis in the United States after cataract surgery are consistent with prior reports. Vitrectomy usage is higher than that recommended from the Endophthalmitis Vitrectomy Study, with no evidence of increased benefit.