ABSTRACT

Objective

To report the clinical features and management outcomes of mixed fungal and bacterial endophthalmitis

Methods

Retrospective, consecutive non-comparative case series. Fifteen eyes of 15 patients were included from January 2009 to December 2019 with culture proven mixed fungal and bacterial endophthalmitis. Demography, clinical presentations, interventions received, and final visual and anatomical outcomes were noted. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit.

Results

The mean age of patients in this series was 34.2 ± 19.6 years (range: 5–61 years). Male preponderance was found in 14 (93.3%). Eight (53.3%) eyes had open globe injury, 5(33.3%) had postoperative endophthalmitis and one (6.6%) each with endogenous endophthalmitis and post-keratitis. Pars plana vitrectomy was done in eight (53.3%) eyes whereas vitreous tap alone was done in seven (46.7%) eyes. Gram positive cocci (n = 11, 73.3%) were the commonest bacterial isolates (n = 7, 46.6%). Staphylococcus aureus (n = 3, 20%) was the most common bacterial isolate. The commonest fungi were filamentous hyaline fungi (n = 5, 33.3%). An unfavorable visual outcome (VA<20/400) was seen in all the eyes. The mean duration of follow-up was 13 ± 18.3 months. Globe salvage was possible only in five (33.3%) eyes. The bacterial isolates were highly sensitive to all of the tested antibiotics.

Conclusion

Mixed fungal and bacterial endophthalmitis occur commonly in a setting of open-globe trauma. The presence of fungus concurrently leads to a very poor management outcome even if the bacterial isolate sensitivity is good.

中文翻译：

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经培养证实的混合细菌和真菌眼内炎的临床表现和治疗结果

摘要

客观的

报告混合性真菌和细菌性眼​​内炎的临床特征和治疗结果

方法

回顾性、连续的非比较病例系列。从 2009 年 1 月到 2019 年 12 月，15 名患者的 15 只眼被纳入培养，结果证实为混合性真菌和细菌性眼​​内炎。记录了人口统计学、临床表现、接受的干预措施以及最终的视觉和解剖结果。良好的解剖结果被定义为保留眼球，没有低张力，视网膜附着，最后一次访问时没有活动性炎症。

结果

该系列患者的平均年龄为 34.2 ± 19.6 岁（范围：5-61 岁）。男性占 14 名（93.3%）。8 只（53.3%）眼有开放性眼球损伤，5 只（33.3%）有术后眼内炎，1 只（6.6%）眼有内源性眼内炎和角膜炎。8 只 (53.3%) 只眼进行了平面部玻璃体切除术，而 7 只 (46.7%) 只眼只进行了玻璃体穿刺。革兰氏阳性球菌（n = 11, 73.3%）是最常见的细菌分离物（n = 7, 46.6%）。金黄色葡萄球菌(n = 3, 20%) 是最常见的细菌分离物。最常见的真菌是丝状透明真菌（n = 5, 33.3%）。在所有眼睛中都看到了不利的视觉结果（VA<20/400）。平均随访时间为 13 ± 18.3 个月。只有五只（33.3%）只眼睛可以进行全球抢救。细菌分离物对所有测试的抗生素都高度敏感。

结论

混合性真菌和细菌性眼​​内炎通常发生在开放性外伤的情况下。即使细菌分离的敏感性很好，真菌的存在也会导致非常差的管理结果。