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Antibiotic susceptibility in Endophthalmitis Management Study and intravitreal antibiotic practice trend in India—EMS Report #5

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Abstract

Aim

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%).

Conclusion

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.

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Funding

This study was funded by the Hyderabad Eye Research Foundation (LEC-01–19-215) to Taraprasad Das.

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Authors and Affiliations

  1. Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India

    Taraprasad Das, Akash Belenje & Vivek Pravin Dave

  2. Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India

    Suchita Pandey & Joveeta Joseph

  3. Retina Service, Shantilal Shanghvi Eye Institute, Mumbai, India

    Jay Sheth

  4. Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, India

    Umesh C. Behera

  5. Anant Bajaj Retina Institute, L V Prasad Eye Institute, Vijayawada, India

    Aditya Kapoor

  6. Anant Bajaj Retina Institute, L V Prasad Eye Institute, Vishakhapatnam, India

    Rudvij Pandya

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  1. Taraprasad Das
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  2. Suchita Pandey
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  3. Joveeta Joseph
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  4. Jay Sheth
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  9. Vivek Pravin Dave
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Contributions

Concepts: TD. Design: TD. Definition of intellectual content: TD, JJ, JS. Literature search: TD. Data acquisition: TD, SP, JJ, JS. Data analysis: TD, SP, JJ, JS. Statistical analysis: VPD. Manuscript preparation: TD. Manuscript editing: TD, JJ, UCB, VPD. Manuscript review: TD, SP, JJ, JS, AB, UCB, AK, RP, VPB. Guarantor: TD.

Corresponding author

Correspondence to Taraprasad Das.

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Declarations

The ethics committee approved the EMS (LEC 01–19-215), and all patients were treated according to the tenets of the Declaration of Helsinki.

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The authors declare no competing interests.

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Das, T., Pandey, S., Joseph, J. et al. Antibiotic susceptibility in Endophthalmitis Management Study and intravitreal antibiotic practice trend in India—EMS Report #5. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06391-3

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  • DOI: https://doi.org/10.1007/s00417-024-06391-3

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