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

PURPOSE: Report the clinico-microbiological characteristics of multidrug-resistant acute postcataract bacterial endophthalmitis.

METHODS

Consecutive 32 cases from a prospective multicenter study in India were analyzed for the clinical features, presenting visual acuity, and inflammation score before and 3 months after treatment. Absolute risk reduction and number needed to treat to avoid globe loss were calculated.

RESULTS

The multidrug-resistant incidence was 7.8% (32/410). It included 28 gram-negative bacilli (GNB, 87.5%) and 4 gram-positive cocci (GPC, 12.5%). The presenting visual acuity was light perception to hand motions in 93.9% (30/32) of patients. The mean inflammation score was 17.34 ± 3.96. The primary treatment was vitrectomy and intravitreal antibiotics; all patients required a second intervention-vitreous lavage and intravitreal antibiotics (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. After treatment, 9.4% of eyes developed phthisis, 46.9% did not improve vision, and 9.4% of eyes had ≥20/40. The absolute risk reduction was higher and the number needed to treat was lower to avoid one globe loss with colistin than with other antibiotics.

CONCLUSION

Colistin could be an alternative to treating multidrug-resistant postcataract endophthalmitis caused by gram-negative bacilli in India.