Endophthalmitis caused by enterococcus faecalis - Antibiotic selection and treatment outcomes
Endophthalmitis caused by enterococcus faecalis - Antibiotic selection and treatment outcomes
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DOI：
10.1016/s0161-6420(03)00502-5
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发表时间：
2003-08-01
期刊：
影响因子：
13.7
通讯作者：
Miller, D
中科院分区：
文献类型：
--
作者：
Scott, IU;Loo, RH;Miller, D
目的：调查粪肠球菌引起的眼内炎的临床环境、治疗策略和视力结果，并确定抗生素敏感性和耐药性模式。设计：回顾性、非比较性、连续病例系列。参与者和方法：回顾了 1990 年 1 月 1 日至 12 月 31 日期间在巴斯科姆帕尔默眼科研究所评估的所有粪肠球菌引起的培养阳性眼内炎患者的记录， 2001.主要结果指标：相关的既往手术程序、临床特征、给予的治疗、抗生素敏感性和耐药性模式以及最终视觉结果。结果：在 29 名患者的 29 只眼睛中发现了由粪肠球菌引起的眼内炎。平均随访时间为 17.8 个月（范围：0.1-86.7 个月）。粪肠球菌引起的眼内炎与以下因素相关：29只眼中的12只眼（41.4%）进行了白内障手术；29只眼中的8只眼进行了小梁切除术（27.6%）；29只眼中的4只眼进行了穿透性角膜移植术（13.8%）；29只眼中的3只眼进行了白内障联合小梁切除术（10.3%）；挂线29 只眼中的 1 只（3.5%）进行了植入术，29 只眼中的 1 只（3.5%）进行了瞳孔成形术。分离株的耐药模式如下：万古霉素23只眼中0只眼（0.0%），利奈唑胺29只眼中0只眼（0.0%），环丙沙星14只眼中1只眼（7.1%），庆大霉素（最低抑菌浓度>8 mg/l）16只眼中8只（50.0%），高浓度庆大霉素（最低抑菌浓度） >500 mg/l），29 只眼中的 5 只眼（17.2%），8 只眼中的 7 只眼（87.5%）使用头孢唑林，29 只眼中的 29 只眼使用奎努普丁和达福普丁（100.0%）。感染前基线视力范围为 20/30 至手部动作。眼内炎患者的视力范围为 2/200 至无光感。最终视力优于或等于20/50者2例（6.9%），20/60～20/400者3例（10.3%），手部运动者5/200者10例（34.5%），光感至无光感者14例（48.3%）。所有测试的分离株均对头孢菌素敏感，但对万古霉素敏感。粪肠球菌引起的眼内炎通常与视力不良有关。 (C) 2003 年由美国眼科学会颁发。
Purpose: To investigate clinical settings, treatment strategies, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis and to determine antibiotic sensitivity and resistance patterns.Design: Retrospective, noncomparative, consecutive case series.Participants and Methods: Records were reviewed of all patients with culture-positive endophthalmitis caused by E faecalis evaluated at the Bascom Palmer Eye Institute between January 1, 1990, and December 31, 2001.Main Outcome Measures: Associated prior surgical procedures, clinical features, treatments administered, antibiotic sensitivity and resistance patterns, and final visual outcomes.Results: Endophthalmitis caused by E faecalis was identified in 29 eyes of 29 patients. The mean follow-up was 17.8 months (range, 0.1-86.7 months). Endophthalmitis caused by E faecalis was associated with, in order of decreasing frequency, cataract surgery in 12 of 29 eyes (41.4%), trabeculectomy in 8 of 29 eyes (27.6%), penetrating keratoplasty in 4 of 29 eyes (13.8%), combined cataract and trabeculectomy in 3 of 29 eyes (10.3%), seton implantation in 1 of 29 eyes (3.5%), and pupilloplasty in 1 of 29 eyes (3.5%). Resistance patterns among the isolates were the following: vancomycin in 0 of 23 eyes (0.0%), linezolid in 0 of 29 eyes (0.0%), ciprofloxacin in 1 of 14 eyes (7.1%), gentamicin (minimum inhibitory concentration >8 mg/l) in 8 of 16 eyes (50.0%), high-level gentamicin (minimum inhibitory concentration >500 mg/l) in 5 of 29 eyes (17.2%), cefazolin in 7 of 8 eyes (87.5%), and quinupristin and dalfopristin in 29 of 29 eyes (100.0%). Preinfection baseline visual acuities ranged from 20/30 to hand motions. Visual acuities on presentation with endophthalmitis ranged from 2/200 to no light perception. Final visual acuity was better than or equal to 20/50 in two cases (6.9%), 20/60 to 20/400 in three cases (10.3%), 5/200 to hand motions in 10 cases (34.5%), and light perception to no light perception in 14 cases (48.3%).Conclusions: E faecalis often is resistant to gentamicin and cephalosporins but was sensitive to vancomycin in all isolates tested. Endophthalmitis caused by E faecalis usually is associated with poor visual outcomes. (C) 2003 by the American Academy of Ophthalmology.