Acute Endophthalmitis After Cataract Surgery from 2007 to 2015; Causative Organisms, Antibiotic Sensitivity and Visual Outcome



To evaluate the clinical characteristics, culture results, antibiograms and visual acuity outcomes of eyes with acute endophthalmitis after cataract surgery.


Retrospective consecutive case series.


126 eyes of 126 patients who presented to a tertiary referral centre in the Netherlands from 2007 to 2015 for acute endophthalmitis after cataract surgery.


All eyes that underwent vitreous biopsy for acute post cataract surgery endophthalmitis were included. Clinical and microbiology data were reviewed. For visual acuity outcome analysis, cases with follow-up less than 3 months were excluded. Bacterial cultures were categorized as “negative” (no growth), “gram-positive coagulase-negative”, “other gram-positive” or “gram-negative”. Data concerning intracameral cefuroxime administration was obtained from referring ophthalmologists for cases that presented between 2010-2015. Main outcome measures: Bacterial culture, antibiotic sensitivity, visual acuity outcome.


Bacterial growth on cultures was observed in 93 of 126 cases (73%). Out of positive bacterial cultures, 49 (53,3%) were gram-positive coagulase-negative, 29 (31,5%) were other gram-positive and 13 (14,1%) were gram-negative. Within gram-negatives, two strains of Morganella Morganii and two strains of Serratia Marcescens were cultured. Of gram-positive strains, 76 of 77 (98,7%) were sensitive for vancomycin and of gram-negative strains, 12 of 12 were sensitive to ceftazidime. In gram-positive coagulase negative cultures, 20 of 44 (45,5 %) were tested sensitive to second generation cephalosporins (cefuroxime). Best achieved visual acuity outcome was ≥ 0.5 in 77 cases (67,5 %), HM – 0.4 in 17 cases (14,0 %) and ≤ light perception in 20 cases (17,5 %). In 25 of 68 cases (36,8%) that presented between 2010-2015, administration of intracameral cefuroxime at the conclusion of surgery was confirmed by the referring ophthalmologist. In these 25 patients, 6 bacterial strains in sensitive and 11 strains sensitive to cefuroxime were cultured.


An increased percentage of gram-negative bacterial strains were cultured, including highly virulent cases of Morganella and Serratia, compared to previous studies. Over half of the gram-positive coagulase negative bacteria that were cultured showed resistance to Cefuroxime. Main contributing organisms to a visual acuity outcome of ≤ light perception were streptococci, Morganella and Serratia species. Bacterial strains sensitive to cefuroxim were cultured in 11 of 25 eyes that developed acute endophthalmitis despite intracameral cefuroxime.



Stefan J.R. de Geus
Nijmegen, Netherlands
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