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.
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.