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Clinical Settings, Antimicrobial Susceptibility, and Management Outcomes

Dave, Vivek Pravin, MD, DNB, FRCS*; Pathengay, Avinash, DO, FRCS; Braimah, Imoro Zeba, MD*; Panchal, Bhavik, MS*; Sharma, Savitri, MD; Pappuru, Rajeev Reddy, MD*; Mathai, Annie, MD*; Tyagi, Mudit, MD*; Narayanan, Raja, MD*; Jalali, Subhadra, MD*; Das, Taraprasad, MD*

doi: 10.1097/IAE.0000000000002462
Original Study: PDF Only

Purpose: To report the clinical presentation and management outcome of patients with endophthalmitis caused by Enterococcus species and to report the susceptibility profile of the isolates.

Methods: Twenty-nine cases with culture-proven Enterococcus endophthalmitis from January 2005 to May 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Favorable visual outcome was final visual acuity ≥20/400.

Results: There were 24 men (82.8%). Mean age at presentation was 32.89 ± 25.25 years (median 24 years). Inciting event was open globe injury in 18 (62%), endogenous in 5 (17.24%), postcataract surgery in 3 (10.34%), postscleral buckling in 2 (6.89%), and postkeratoplasty in 1 (3.44%). Enterococcus casseliflavus was the commonest species isolated (14/29, 48.27%) followed by E. faecalis (9/29, 31%). Susceptibility to vancomycin was seen in 27/29 isolates (93%). Visual acuity was ≤20/400 in all eyes at presentation and ≥20/400 in 10/29 cases (34.48%) at final visit. Anatomical success was seen in 18/29 eyes (62%). Corneal involvement was high at 24/29 eyes (82.75%).

Conclusion: Enterococcus is not an uncommon organism in the setting of endophthalmitis after open globe injury. Resistance to vancomycin is rare. Multidrug resistance pattern is restricted to E. faecalis. Visual outcome is poor despite early and appropriate therapy due to inherent organism virulence.

In this communication, we describe the clinical presentations, microbiology, and management outcomes of Enterococci, a relatively uncommon but clinically significant etiology of endophthalmitis.

*Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India;

Retina-Vitreous Services, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India; and

Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.

Reprint requests: Avinash Pathengay, DO, FRCS, Srimati Kanuri Santhamma Center for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India; e-mail:

Supported by the Hyderabad Eye Research Foundation.

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.