Abstract：
OBJECTIVE: Analyze antibiotic susceptibility in the Endophthalmitis Management Study (EMS) and compare it with the current intravitreal antibiotic practice trend of members of the Vitreoretinal Society of India (VRSI) practicing in India.
METHODS: The microbiology work-up of undiluted vitreous included microscopy, culture-susceptibility, polymerase chain reaction (PCR), and next-generation sequencing (NGS). VRSI members were invited to the survey. The EMS conventional culture-susceptibility (PCR and NGS excluded) results were compared vis-a-vis gram-positive cocci (GPC), gram-negative bacilli (GNB), and less commonly used antibiotics with the current recommended intravitreal antibiotics. p < 0.05 was considered significant.
RESULTS: Culture and positivity (culture + PCR/NGS) positivity was 28.8% and 56.1%, respectively. GPC was most susceptible to cefazolin, linezolid, and vancomycin; GNB was most susceptible to amikacin, ceftazidime, colistin, and imipenem. There was no susceptibility difference between cefazolin and vancomycin (p = 0.999) and between ceftazidime and imipenem (p = 1.0). Colistin was superior to ceftazidime (p = 0.047) against GNB. The GNB resistant to amikacin (n = 14) were equally susceptible to ceftazidime and colistin; resistant to ceftazidime (n = 16) were susceptible to colistin; and resistant to colistin (n = 7) were susceptible to ceftazidime. The preference of VRSI members (n = 231) practicing in India was a vancomycin-ceftazidime combination (82%), vancomycin for GPC (94%), ceftazidime for GNB (61%), and voriconazole for fungi (74%).
CONCLUSIONS: In EMS, GPC had good susceptibility to vancomycin; GNB had good susceptibility to ceftazidime and colistin. Given the lower resistance of colistin, a vancomycin-colistin combination could be an alternative empiric treatment in post-cataract endophthalmitis in India.
METHODS: The microbiology work-up of undiluted vitreous included microscopy, culture-susceptibility, polymerase chain reaction (PCR), and next-generation sequencing (NGS). VRSI members were invited to the survey. The EMS conventional culture-susceptibility (PCR and NGS excluded) results were compared vis-a-vis gram-positive cocci (GPC), gram-negative bacilli (GNB), and less commonly used antibiotics with the current recommended intravitreal antibiotics. p < 0.05 was considered significant.
RESULTS: Culture and positivity (culture + PCR/NGS) positivity was 28.8% and 56.1%, respectively. GPC was most susceptible to cefazolin, linezolid, and vancomycin; GNB was most susceptible to amikacin, ceftazidime, colistin, and imipenem. There was no susceptibility difference between cefazolin and vancomycin (p = 0.999) and between ceftazidime and imipenem (p = 1.0). Colistin was superior to ceftazidime (p = 0.047) against GNB. The GNB resistant to amikacin (n = 14) were equally susceptible to ceftazidime and colistin; resistant to ceftazidime (n = 16) were susceptible to colistin; and resistant to colistin (n = 7) were susceptible to ceftazidime. The preference of VRSI members (n = 231) practicing in India was a vancomycin-ceftazidime combination (82%), vancomycin for GPC (94%), ceftazidime for GNB (61%), and voriconazole for fungi (74%).
CONCLUSIONS: In EMS, GPC had good susceptibility to vancomycin; GNB had good susceptibility to ceftazidime and colistin. Given the lower resistance of colistin, a vancomycin-colistin combination could be an alternative empiric treatment in post-cataract endophthalmitis in India.
摘要：
目的：分析眼内炎管理研究（EMS）中的抗生素敏感性，并将其与印度玻璃体视网膜协会（VRSI）成员在印度的玻璃体内抗生素使用趋势进行比较。
方法：未稀释玻璃体的微生物学检查包括显微镜检查，文化易感性，聚合酶链反应（PCR），和下一代测序（NGS）。VRSI成员被邀请参加调查。EMS常规培养-敏感性（PCR和NGS除外）结果与革兰氏阳性球菌（GPC）相比，革兰氏阴性杆菌（GNB），和较少使用的抗生素与目前推荐的玻璃体内抗生素。p<0.05被认为是显著的。
结果:培养阳性(培养+PCR/NGS)分别为28.8%和56.1%,分别。GPC对头孢唑啉最敏感,利奈唑胺,和万古霉素；GNB对阿米卡星最敏感，头孢他啶,粘菌素,还有亚胺培南.头孢唑啉与万古霉素(p=0.999)、头孢他啶与亚胺培南(p=1.0)药敏无差异。对GNB,粘菌素优于头孢他啶(p=0.047)。对阿米卡星耐药的GNB(n=14)对头孢他啶和粘菌素同样敏感；对头孢他啶耐药的GNB(n=16)对粘菌素敏感；对粘菌素耐药的GNB(n=7)对头孢他啶敏感。在印度执业的VRSI成员（n=231）的偏好是万古霉素-头孢他啶组合（82％），万古霉素用于GPC（94%），头孢他啶用于GNB（61%），和伏立康唑对真菌（74％）。
结论：在EMS中，GPC对万古霉素具有良好的敏感性；GNB对头孢他啶和粘菌素具有良好的敏感性。鉴于粘菌素的电阻较低，万古霉素-粘菌素联合治疗可能是印度白内障后眼内炎的替代经验性治疗方法.
方法：未稀释玻璃体的微生物学检查包括显微镜检查，文化易感性，聚合酶链反应（PCR），和下一代测序（NGS）。VRSI成员被邀请参加调查。EMS常规培养-敏感性（PCR和NGS除外）结果与革兰氏阳性球菌（GPC）相比，革兰氏阴性杆菌（GNB），和较少使用的抗生素与目前推荐的玻璃体内抗生素。p<0.05被认为是显著的。
结果:培养阳性(培养+PCR/NGS)分别为28.8%和56.1%,分别。GPC对头孢唑啉最敏感,利奈唑胺,和万古霉素；GNB对阿米卡星最敏感，头孢他啶,粘菌素,还有亚胺培南.头孢唑啉与万古霉素(p=0.999)、头孢他啶与亚胺培南(p=1.0)药敏无差异。对GNB,粘菌素优于头孢他啶(p=0.047)。对阿米卡星耐药的GNB(n=14)对头孢他啶和粘菌素同样敏感；对头孢他啶耐药的GNB(n=16)对粘菌素敏感；对粘菌素耐药的GNB(n=7)对头孢他啶敏感。在印度执业的VRSI成员（n=231）的偏好是万古霉素-头孢他啶组合（82％），万古霉素用于GPC（94%），头孢他啶用于GNB（61%），和伏立康唑对真菌（74％）。
结论：在EMS中，GPC对万古霉素具有良好的敏感性；GNB对头孢他啶和粘菌素具有良好的敏感性。鉴于粘菌素的电阻较低，万古霉素-粘菌素联合治疗可能是印度白内障后眼内炎的替代经验性治疗方法.
