Analysis of pathogenic factors and etiological characteristics of 531 patients with suppurative endophthalmitis_Chinese Journal of Ocular Fundus Diseases

Authors：

Wan Lei , Chen Nan , Zhang Jing , Cheng Jun , Liu Fang ,  Xie Lixin

Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, China;

Corresponding author：

Xie Lixin, Email: lixin_xie@hotmail.com

Keywords：

Endophthalmitis/epidemiology; Endophthalmitis/microbiology; Endophthalmitis/etiology; Endophthalmitis/prevention & control

DOI：

10.3760/cma.j.issn.1005-1015.2019.02.014

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Objective To analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.Methods A total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study. Among them, 410 patients with 410 eyes were males (77.2%), 121 patients with 121 eyes were females (22.8%). The average age of the patients was 38.62±15.36 years. The relevant medical records were collected to analyze the pathogenic factors. Samples of aqueous humor, vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.Results Ocular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1%), other factors included postoperative endophthalmitis (19.0%), suppurative keratitis-related endophthalmitis (17.1%) and endogenous endophthalmitis (3.8%). Postoperative endophthalmitis mainly occured after cataract surgery. A total of 224 strains of organisms were isolated, among which the predominant organisms isolated were gram-positive bacteria (54.0%) and staphylococcus epidermidis was the most common (25.0%). The other pathogenic organisms were fungi (29.5%) and gram-negative bacteria (16.5%). Among the fungi, aspergillus (10.7%) was the dominant genus, followed by fusarium (9.8%). For gram-positive organisms, susceptibilities were vancomycin 97.4%, gatifloxacin 91.8%, fusidate acid 77.9% and levofloxacin 54.6%. For gram-negative organisms, susceptibilities were gatifloxacin 85.7%, levofloxacin 77.8%, tobramycin 71.4% and ceftazidime 62.5%. For fungal isolates, sensitivities were voriconazole 88.2% and amphotericin B 84.8%.Conclusions Ocular trauma is the main pathogenic factor of suppurative endophthalmitis, followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis. Gram-positive bacteria are the major pathogenic organisms, especially staphylococcus epidermidis followed by fungal species, among which aspergillus and fusarium were the dominating pathogenic genus.

Citation： Wan Lei, Chen Nan, Zhang Jing, Cheng Jun, Liu Fang, Xie Lixin. Analysis of pathogenic factors and etiological characteristics of 531 patients with suppurative endophthalmitis. Chinese Journal of Ocular Fundus Diseases, 2019, 35(2): 181-186. doi: 10.3760/cma.j.issn.1005-1015.2019.02.014 Copy

1.	Liu C, Ji J, Li S, et al. Microbiological isolates and antibiotic susceptibilities: a 10-year review of culture-proven endophthalmitis cases[J]. Curr Eye Res, 2017, 42(3): 443-447. DOI: 10.1080/02713683.2016.1188118.
2.	黎晓新, 张正. 眼内炎的诊断与处理及预防[J]. 中华眼科杂志, 2006, 42(10): 946-950. DOI: 10.3760/j:issn:0412-4081.2006.10.022.Li XX, Zhang Z. Diagnosis, management and prevention of endophthalmitis[J]. Chin J Ophthalmol, 2006, 42(10): 946-950. DOI: 10.3760/j:issn:0412-4081.2006.10.022.
3.	段灵, 张美霞, 刘谊. 感染性眼内炎研究现状及进展[J]. 中华眼底病杂志, 2008, 24(6): 471-473.Duan L, Zhang MX, Liu Y, et al. Research status and progress on infective endophthalmitis[J]. Chin J Ocul Fundus Dis, 2008, 24(6): 471-473.
4.	陈蕊, 谢立信, 孙士营, 等. 感染性眼内炎282例临床分析[J]. 中华眼底病杂志, 2008, 24(6): 402-405.Chen R, Xie LX, Sun SY, et al. Clinical analysis of 282 patients with infectious endophthalmitis[J]. Chin J Ocul Fundus Dis, 2008, 24(6): 402-405.
5.	Duan F, Wu K, Liao J, et al. Causative microorganisms of infectious endophthalmitis: a 5-year retrospective study [J/OL]. J Ophthalmol, 2016, 2016: 6764192[2016-06-19]. https://dx.doi.org/10.1155/2016/6764192. DOI: 10.1155/2016/6764192.
6.	Moloney TP, Joseph P. Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15-year review[J]. Br J Ophthalmol, 2014, 98(11): 1492-1497. DOI: 10.1136/bjophthalmol-2014-305030.
7.	Bhattacharjee H, Bhattacharjee K, Gogoi K, et al. Microbial profile of the vitreous aspirates in culture proven exogenous endophthalmitis: a 10-year retrospective study[J]. Indian J Med Microbiol, 2016, 34(2): 153-158. DOI: 10.4103/0255-0857.180280.
8.	王伟, 徐海峰, 原公强, 等. 外伤性感染性眼内炎病因和致病菌临床分析[J]. 中华眼外伤职业眼病杂志, 2002, 24(5): 490-492. DOI: 10.3760/cma.j.issn.2095-1477.2002.05.004.Wang W, Xu HF, Yuan GQ, et al. Clinical analysis of etiology and pathogen of infectious endophthalmitis[J]. Chin J Ocul Traum Occupat Eye Dis, 2002, 24(5): 490-492. DOI: 10.3760/cma.j.issn.2095-1477.2002.05.004.
9.	程钧, 孙伟, 谢立信. 青光眼滤过泡相关性眼内炎的临床分析[J]. 中华眼科杂志, 2011, 47(2): 114-121. DOI: 10.3760/cma.j.issn.0412-4081.2011.02.005.Cheng J, Sun W, Xie LX. Clinical analysis of glaucoma bleb-associated endophthalmitis[J]. Chin J Ophthalmol, 2011, 47(2): 114-121. DOI: 10.3760/cma.j.issn.0412-4081.2011.02.005.
10.	曹向荣, 龚力力, 杨漪, 等. 超声乳化白内障吸除术后眼内炎的临床分析[J]. 中华眼科杂志, 2005, 41(6): 519-522. DOI: 10.3760/j:issn:0412-4081.2005.06.010.Cao XR, Gong LL, Yang Y, et al. Endophthalmitis after phacoemucification surgery[J]. Chin J Ophthalmol, 2005, 41(6): 519-522. DOI: 10.3760/j:issn:0412-4081.2005.06.010.
11.	Hatch WV, Cernat G, Wong D, et al. Risk factors for acute endophthalmitis after cataract surgery: a population-based study[J]. Ophthalmology, 2009, 116(3): 425-430. DOI: 10.1016/j.ophtha.2008.09.039.
12.	Cao H, Zhang L, Li L, et al. Risk factors for acute endophthalmitis following cataract surgery: a systematic review and meta-analysis [J/OL]. PLoS One, 2013, 8(8): 71731[2013-08-26]. http://dx.plos.org/10.1371/journal.pone.0071731. DOI: 10.1371/journal.pone.0071731.
13.	Garg P, Roy A, Sharma S. Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection[J]. Curr Opin Ophthalmol, 2017, 28(1): 67-72. DOI: 10.1097/ICU.0000000000000326.
14.	Alice S, Scott IU, Flynn HW, et al. Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes[J]. Ophthalmology, 2002, 109(5): 985-991. DOI: 10.1016/S0161-6420(02)00965-X.
15.	Mollan SP, Gao A, Lockwood A, et al. Postcataract endophthalmitis: Incidence and microbial isolates in a united kingdom region from 1996 through 2004[J]. J Cataract Refract Surg, 2007, 33(2): 265-268. DOI: 10.1016/j.jcrs.2006.10.022.
16.	Schimel AM, Darlene M, Flynn HW. Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases[J]. Am J Ophthalmol, 2013, 156(1): 50-52. DOI: 10.1016/j.ajo.2013.09.007.
17.	罗益文, 黄文彬, 李娉, 等. 外伤性枯草杆菌性眼内炎临床分析[J]. 实用医学杂志, 2016, 32(17): 2833-2836. DOI: 10.3969/j.issn.1006-5725.2016.17.015.Luo YW, Huang WB, Li P, et al. A retrospective review of twenty-two cases with traumatic endophthalmitis caused by bacillua subtilis[J]. J Practi Med, 2016, 32(17): 2833-2836. DOI: 10.3969/j.issn.1006-5725.2016.17.015.
18.	Xie L, Hu J, Shi W. Treatment failure after lamellar keratoplasty for fungal keratitis[J]. Ophthalmology, 2008, 115(1): 33-36. DOI: 10.1016/j.ophtha.2007.03.072.
19.	Shi W, Wang T, Xie LX, et al. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation[J]. Ophthalmology, 2010, 117(5): 890-896. DOI: 10.1016/j.ophtha.2009.10.004.
20.	Wykoff CC, Flynn HW, Darlene M, et al. Exogenous fungal endophthalmitis: microbiology and clinical outcomes[J]. Ophthalmology, 2008, 115(9): 1501-1507. DOI: 10.1016/j.ophtha.2008.02.027.
21.	Carifi G, Zygoura V, Pitsas C, et al. Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases[J]. Am J Ophthalmol, 2013, 156(6): 1321-1322. DOI: 10.1016/j.ajo.2013.01.027.
22.	Sharma N, Singhal D, Maharana PK, et al. Comparison of oral voriconazole versus oral ketoconazole as an adjunct to topical natamycin in severe fungal keratitis: a randomized controlled trial[J]. Cornea, 2017, 36(12): 1521-1527. DOI: 10.1097/ICO.0000000000001365.
23.	Laniado-Laborin R, Cabrales-Vargas MN. Amphotericin B: side effects and toxicity[J]. Rev Iberoam Micol, 2009, 26(4): 223-227. DOI: 10.1016/j.riam.2009.06.003.

1. Liu C, Ji J, Li S, et al. Microbiological isolates and antibiotic susceptibilities: a 10-year review of culture-proven endophthalmitis cases[J]. Curr Eye Res, 2017, 42(3): 443-447. DOI: 10.1080/02713683.2016.1188118.
2. 黎晓新, 张正. 眼内炎的诊断与处理及预防[J]. 中华眼科杂志, 2006, 42(10): 946-950. DOI: 10.3760/j:issn:0412-4081.2006.10.022.Li XX, Zhang Z. Diagnosis, management and prevention of endophthalmitis[J]. Chin J Ophthalmol, 2006, 42(10): 946-950. DOI: 10.3760/j:issn:0412-4081.2006.10.022.
3. 段灵, 张美霞, 刘谊. 感染性眼内炎研究现状及进展[J]. 中华眼底病杂志, 2008, 24(6): 471-473.Duan L, Zhang MX, Liu Y, et al. Research status and progress on infective endophthalmitis[J]. Chin J Ocul Fundus Dis, 2008, 24(6): 471-473.
4. 陈蕊, 谢立信, 孙士营, 等. 感染性眼内炎282例临床分析[J]. 中华眼底病杂志, 2008, 24(6): 402-405.Chen R, Xie LX, Sun SY, et al. Clinical analysis of 282 patients with infectious endophthalmitis[J]. Chin J Ocul Fundus Dis, 2008, 24(6): 402-405.
5. Duan F, Wu K, Liao J, et al. Causative microorganisms of infectious endophthalmitis: a 5-year retrospective study [J/OL]. J Ophthalmol, 2016, 2016: 6764192[2016-06-19]. https://dx.doi.org/10.1155/2016/6764192. DOI: 10.1155/2016/6764192.
6. Moloney TP, Joseph P. Microbiological isolates and antibiotic sensitivities in culture-proven endophthalmitis: a 15-year review[J]. Br J Ophthalmol, 2014, 98(11): 1492-1497. DOI: 10.1136/bjophthalmol-2014-305030.
7. Bhattacharjee H, Bhattacharjee K, Gogoi K, et al. Microbial profile of the vitreous aspirates in culture proven exogenous endophthalmitis: a 10-year retrospective study[J]. Indian J Med Microbiol, 2016, 34(2): 153-158. DOI: 10.4103/0255-0857.180280.
8. 王伟, 徐海峰, 原公强, 等. 外伤性感染性眼内炎病因和致病菌临床分析[J]. 中华眼外伤职业眼病杂志, 2002, 24(5): 490-492. DOI: 10.3760/cma.j.issn.2095-1477.2002.05.004.Wang W, Xu HF, Yuan GQ, et al. Clinical analysis of etiology and pathogen of infectious endophthalmitis[J]. Chin J Ocul Traum Occupat Eye Dis, 2002, 24(5): 490-492. DOI: 10.3760/cma.j.issn.2095-1477.2002.05.004.
9. 程钧, 孙伟, 谢立信. 青光眼滤过泡相关性眼内炎的临床分析[J]. 中华眼科杂志, 2011, 47(2): 114-121. DOI: 10.3760/cma.j.issn.0412-4081.2011.02.005.Cheng J, Sun W, Xie LX. Clinical analysis of glaucoma bleb-associated endophthalmitis[J]. Chin J Ophthalmol, 2011, 47(2): 114-121. DOI: 10.3760/cma.j.issn.0412-4081.2011.02.005.
10. 曹向荣, 龚力力, 杨漪, 等. 超声乳化白内障吸除术后眼内炎的临床分析[J]. 中华眼科杂志, 2005, 41(6): 519-522. DOI: 10.3760/j:issn:0412-4081.2005.06.010.Cao XR, Gong LL, Yang Y, et al. Endophthalmitis after phacoemucification surgery[J]. Chin J Ophthalmol, 2005, 41(6): 519-522. DOI: 10.3760/j:issn:0412-4081.2005.06.010.
11. Hatch WV, Cernat G, Wong D, et al. Risk factors for acute endophthalmitis after cataract surgery: a population-based study[J]. Ophthalmology, 2009, 116(3): 425-430. DOI: 10.1016/j.ophtha.2008.09.039.
12. Cao H, Zhang L, Li L, et al. Risk factors for acute endophthalmitis following cataract surgery: a systematic review and meta-analysis [J/OL]. PLoS One, 2013, 8(8): 71731[2013-08-26]. http://dx.plos.org/10.1371/journal.pone.0071731. DOI: 10.1371/journal.pone.0071731.
13. Garg P, Roy A, Sharma S. Endophthalmitis after cataract surgery: epidemiology, risk factors, and evidence on protection[J]. Curr Opin Ophthalmol, 2017, 28(1): 67-72. DOI: 10.1097/ICU.0000000000000326.
14. Alice S, Scott IU, Flynn HW, et al. Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes[J]. Ophthalmology, 2002, 109(5): 985-991. DOI: 10.1016/S0161-6420(02)00965-X.
15. Mollan SP, Gao A, Lockwood A, et al. Postcataract endophthalmitis: Incidence and microbial isolates in a united kingdom region from 1996 through 2004[J]. J Cataract Refract Surg, 2007, 33(2): 265-268. DOI: 10.1016/j.jcrs.2006.10.022.
16. Schimel AM, Darlene M, Flynn HW. Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases[J]. Am J Ophthalmol, 2013, 156(1): 50-52. DOI: 10.1016/j.ajo.2013.09.007.
17. 罗益文, 黄文彬, 李娉, 等. 外伤性枯草杆菌性眼内炎临床分析[J]. 实用医学杂志, 2016, 32(17): 2833-2836. DOI: 10.3969/j.issn.1006-5725.2016.17.015.Luo YW, Huang WB, Li P, et al. A retrospective review of twenty-two cases with traumatic endophthalmitis caused by bacillua subtilis[J]. J Practi Med, 2016, 32(17): 2833-2836. DOI: 10.3969/j.issn.1006-5725.2016.17.015.
18. Xie L, Hu J, Shi W. Treatment failure after lamellar keratoplasty for fungal keratitis[J]. Ophthalmology, 2008, 115(1): 33-36. DOI: 10.1016/j.ophtha.2007.03.072.
19. Shi W, Wang T, Xie LX, et al. Risk factors, clinical features, and outcomes of recurrent fungal keratitis after corneal transplantation[J]. Ophthalmology, 2010, 117(5): 890-896. DOI: 10.1016/j.ophtha.2009.10.004.
20. Wykoff CC, Flynn HW, Darlene M, et al. Exogenous fungal endophthalmitis: microbiology and clinical outcomes[J]. Ophthalmology, 2008, 115(9): 1501-1507. DOI: 10.1016/j.ophtha.2008.02.027.
21. Carifi G, Zygoura V, Pitsas C, et al. Endophthalmitis isolates and antibiotic susceptibilities: a 10-year review of culture-proven cases[J]. Am J Ophthalmol, 2013, 156(6): 1321-1322. DOI: 10.1016/j.ajo.2013.01.027.
22. Sharma N, Singhal D, Maharana PK, et al. Comparison of oral voriconazole versus oral ketoconazole as an adjunct to topical natamycin in severe fungal keratitis: a randomized controlled trial[J]. Cornea, 2017, 36(12): 1521-1527. DOI: 10.1097/ICO.0000000000001365.
23. Laniado-Laborin R, Cabrales-Vargas MN. Amphotericin B: side effects and toxicity[J]. Rev Iberoam Micol, 2009, 26(4): 223-227. DOI: 10.1016/j.riam.2009.06.003.

Chinese Journal of Ocular Fundus Diseases

Analysis of pathogenic factors and etiological characteristics of 531 patients with suppurative endophthalmitis

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