Título

ENDOPHTHALMITIS CAUSED BY S. EPIDERMIDIS: FROM DIAGNOSIS TO TREATMENT AND FOLLOW-UP

Objetivo

Diagnosis and treatment guidelines for bacterial endopthalmitis are primarily based on Endophthalmitis Vitrectomy Study (1995) for postoperative endophthalmitis. In this study we report clinical features, antibiotic susceptibility and visual acuity outcomes with endophthalmitis by Staphylococcus epidermidis.

Método

This retrospective study included 20 cases (20 eyes) of endophthalmitis caused by S. epidermidis and treated between October 2015 and July 2017 at the Department of Ophthalmology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (n=14 eyes) and at external private outpatient clinics (n=7 eyes). We analyzed the type of intervention, time elapsed before diagnosis, diagnosis, and 3-mo post-intervention visual acuity. This study was approved by the Institutional Ethics Committee.

Resultado

Thirteen cases (65%) were associated with phacoemulsification . Initial treatment was vitreous tap plus antibiotics injection in 14 eyes (70%) (being 12 of these 14 cases - 85.7% - from public healthcare settings) and pars plana vitrectomy (PPV) in 6 eyes (30%) (being 5 cases - 83.3% - from private clinics). All isolates were sensitive to vancomycin and linezolid. Susceptibility to methicillin, and moxifloxacin and ciprofloxacin was present in 25% and 15%, respectively. Visual acuity was 20/60 or better in 14 of 20 eyes (70%), and there was no difference concerning initial treatment carried out (35.7% in vitreous tap plus one injection, 14.3% plus 2 injections, 14.3% injection and PPV, versus 35.7% only PPV) . Methicillin or fluoroquinolone resistance was not found to be predictor of less favorable visual outcomes. (p=0.03, Fisher's test).

Conclusão

S. epidermidis was sensitive to vancomycin and linezolid. Visual acuity outcomes were not dependent on initial treatment procedure or on methicillin or fluoroquinolone sensitivity. This single pathogen case series provides a better understanding of the aggressiveness of S. epidermidis.