Clinical Study On The Endophthalmitis In PLA General Hospital Over The Last 10 Years

ObjectiveTo analyze the occurrence characteristics of endophthalmitis, the results of bacterial culture and the sensitivity changes of antibiotic in the patients with endophthalmitis by 10 years'cases reviewing.MethodA retrospective case series clinical studies. From January 2000 to December 2009,172 eyes of 165 patients were selected. The patients with endophthalmitis were as the following:endophthalmitis occurred during hospitalization because of the ocular trauma and post-operative occurred endophthalmitis in the Department of Ophthalmology, The General Hospital of PLA, referred patient with endophthalmitis from other local hospitals. The ratio of endophthalmitis among the gereral hospitalization in the same time, the incidence of postoperative endophthalmitis, the pathogenic bacteria culture results, the antibiotic sensitivity changes, the therapeutic result and the characteristic of endogenous endophthalmitis were analysed. The statistical software SPSS 13.0 were used to analyse the data.The variables in normal distribution were compared by independent sample t-tests, the qualitative data were compared by R X C table, endophthalmitis related risk factors were analyzed by Logistic regression model. P<0.05 as significantly different standards.ResultsOver the past 10 years, among the all hospitalized patients,165 patients were suffered form endophthalmitis, the ratio was 1.03%. Endophthalmitis occurred in 12 eyes of 12 patients during hospital stay because of ocular trauma or following cataract surgury in our department, their ratio was 0.098% among the all intraocular opertive patients, nine of the 12 patients were caract patients, the incidence of endophthalmitis was 0.1% in all cases undergone cataract surgery. The ohter 153 patients (160 eyes) were referred cases and they accounting for 93.0% of the all patients with endophthalmitis. Endogenous endophthalmitis was diagnosed in 30 eyes of 24 patients, it accounting for 14.5% of endophthalmitis,142 eyes of 141 were exogenous endophthalmitis cases, they were 85.5% of all endophthalmitis cases, the ratio of endogenous endophthalmitis to exogenous endophthalmitis was 1:5.9. Withing the the first 5 years, endogenous endophthalmitis was diagnosed in 6 patients, it was 7.9% of all endophthalmitis which was daignosed within this period of time; and within recent 5 years,18 patients with endogenous endophthalmitis were hospitalized, its ratio was 20.2% of all patients with endophthalmitis that was diagnosed within the recent 5 years, the difference was statistically significant (P= 0.0251). The causes and the ratio of endophthalmitis were as the following: traumatic endophthalmitis was in 89 patients (53.9%); postoperative endophthalmitis was in 43 patients (26.1%); endogenous endophthalmitis induced by differentin causes was in 24 patients (14.5%); exogenous endophtalmitis that was resulted from other causes was in 9 patients (5.5%). The time interval from the symptom appearance of endophthalmitis to the diagnosis of endophthalmitis esteblishment was as the following:exogenous endophthalmitis was 1-30d (mean was 3.75d); endogenous endophthalmitis was 3-60d (mean was 21.25d), compared by completely random design approximate t-tests (p= 0.001), the difference was statistically significant.Among the all 165 patients,152 patients had a aqueous/vitreous samples pathogenic bacteria culture.42 of them had a positive result, the positive rate was 27.6%. The result of pathogenic agents culture showed that 28 (66.7%) eyes with endophtalmitis were positive in bactera culture,12(28.6%) eyes was postive in fungus culture,2(4.7%) was postive in combined infection, compared by completely random design chi square test(p=0), the difference is statistical significant. Pathogenic agent culture paostive was observed in 31 of the 128 eyes with exogenous endophthalmitis, the positive rate was 24.2% (31/128); the positive rate was 45.8% (11/24) in the patients with endogenous endophthalmitis, the difference is statistical significant (P=0.0298). The consists of the pathogenic agents were as the following:80.6% of the pathogenic agents was bacteria in exogenous group, the main pathogenic agents in endogenous endophthalmitis was fungus(7/11,63%). The results of the bacterial susceptibility to the bacteria:Gram-positive bacteria remain highly sensitive to vancomycin, followed by rifampicin and sulfamethoxazole. But the sensitivity test results in all these three strains show that the bacteriostasis cingula of rifampin and sulfamethoxazole(S30-40mm) is significantly larger than vancomycin (S18-26mm).The cure rate of treatment for endophthalmitis by intravitreal injection of vancomycin (1.Omg/0.1ml) combine with intravenous third-generation cephalosporin was 69.8% in postoperative endophthalmitis,4.5% in traumatic endophthalmitis, and 10% in endogenous endophthalmitis, chi square test result display that the cure rate difference was significantly (p=0). The post-therapeutic best corrected visual acuity was 0.05 or more in 23 eyes. compared that with the BCVA before treatment, the difference was significant. However, there were still 85.9%(140/163) of patients had a best corected visual acuity less than 0.05, the general prognosis is much poor. Logistic regression was used to screen risk factors for visual acuity less than 0.05, the result show the statistically significant factors that cause the visual acuity less than 0.05 after treatment include age, initial visual acuity and whether treated surgically(p=0). Eyeball enucleation was performed in 13 eyes, accountting for 7.56% of all endophthalmitis in the same period, compared to statistics datas of 17.95% (21/116) in our department 10 years ago, the difference was significantly (p=0.0097).Conclusions In recent years, the rate of endogenous endophthalmitis was rised much more sigcificantlly than that occurred in the past five years. The time interval from the onset to diagnosis and treatment in endogenous endophthalmitis patients was longer than that in exogenous endophthalmitis patients (p= 0.001). On the other hand, the main pathogenic agent was fungal in endogenous endophthalmitis and no therapeutic effect after intravitreal injection of vancomycin 1.Omg/0.1ml or combined with third generation cephalosporins, vitreous surgery was strongly indicated. Exogenous endophthalmitis mainly caused by bacterial infection, the culture positive rate of the specimens was low and saticified effective could be obtained by drug treatment.Susceptibility test results showed that G-positive bacteria is still highly sensitive to vancomycin, but the sensitivity decreased. While, the sensitivity of rifampin and sulfamethoxazole is higher. In recent years, although eyeball enucleation as a method for endophthalmitis was significantly reduced, and the better results had been achived, poor post-theraputic visual acuity improvement is still one of the problemes. The statistically significant factors that cause the visual acuity less than 0.05 after treatment include age, initial visual acuity, whether treated surgically.