Clinical Analysis of Infectious Endophthalmitis from the Largest Medical Center in North China: A 30-Year Review

Purpose: To analyse clinical features and prognosis of infectious endophthalmitis, and provide basis for the treatment. Methods: : Retrospective clinical data analysis for 485 eyes (479 patients) in the past 30 years (1993-2022). Demographic features, clinic-microbiological profile, antimicrobial susceptibilities, and visual outcomes were analysed. Results: : The mean age of patients was 41.6±22.6 years and 72.0% were males. The mean age of Endogenous endophthalmitis (EnE) patients was elder than that of Exogenous endophthalmitis (ExE) patients, but there was no difference in sex ratio. The percentage of ExE was 86.0% and that of EnE was14.0%. Gram positive cocci (GPC) (39.3%) was the commonest pathogen, followed by Gram negative bacilli (GNB) (32.0%), fungi (16.4%), Gram positive bacilli (GPB) (11.4%), and Gram negative cocci (GNC) (0.9%). Vancomycin owned 100% susceptibility to GPC and GPB. Ceftazidime and imipenem owned the same as the best susceptibility to GPB (both 91.5%). Top three pathogens in ExE were Staphylococcus epidermidis, Staphylococcus aureus and Pseudomonas aeruginosa respectively. Top three etiologies of ExE were ocular trauma, ophthalmologic surgery and infectious keratitis. Top three surgery related with ExE were: cataract extraction, intravitreal injection and vitrectomy. Top three pathogens in EnE were Klebsiella pneumoniae, Candida albicans, Staphylococcus epidermidis respectively . Total best corrected visual acuity (hereinafter referred to as VA) of admission was 2.54 ± 0.62 and improved to 2.12 ±0.93 ( P < 0.05). VA related with GPC or fungi increased after the treatment, and there was no significant improvement both in GNB and GPB. VA of ExE increased after the treatment, but did not change significantly in EnE. Final VA of ExE was superior to EnE. Conclusions: : GPC was the commonest pathogen in endophthalmitis, and Staphylococcus epidermidis was the commonest pathogen in ExE. Combination of vancomycin and ceftazidime covered the broadest spectrum of bacteria in endophthalmitis. ExE, GPC and fungi infection were related with good prognosis (improved VA).