Multidrug-Resistant Endophthalmitis Rates and Treatment Outcomes Revealed

Strategic Insights -

Researchers in India have conducted a study to report the clinico-microbiological characteristics of multidrug-resistant (MDR) acute post-cataract bacterial endophthalmitis. The researchers analyzed 32 consecutive cases from a prospective multi-center study in India and found that the MDR incidence was 7.8% (32/410), with 28 gram-negative bacilli (GNB) and 4 gram-positive cocci (GPC). The primary treatment was vitrectomy and intravitreal antibiotics (IVT), with all patients requiring a second intervention - vitreous lavage and IVT. The researchers found that GNBs were resistant to fluoroquinolones, aminoglycosides, and cephalosporins (39.3% each) and polymyxins (17.6%), but most amikacin- and ceftazidime-resistant (81.8%) GNBs were susceptible to colistin.

Key Takeaways:

  • The multidrug-resistant (MDR) incidence of acute post-cataract bacterial endophthalmitis was 7.8% (32/410) in the study of 32 consecutive cases from a prospective multi-center study in India.
  • Gram-negative bacilli (GNB) accounted for 87.5% (28/32) of the cases, with gram-positive cocci (GPC) accounting for 12.5% (4/32).
  • The primary treatment was vitrectomy and intravitreal antibiotics (IVT), with all patients requiring a second intervention - vitreous lavage and IVT.
  • The mean inflammation score (IS) was 17.34 + 3.96 before treatment, with light perception to hand motions being the presenting visual acuity (PVA) in 93.9% (30/32) of patients.
  • The absolute risk reduction (ARR) was higher and the number needed to treat (NNT) was lower to avoid one globe loss with colistin compared to other antibiotics.
  • Colistin was found to be an alternative to treating multidrug-resistant post-cataract endophthalmitis caused by gram-negative bacilli in India.

Statistics:

  • 7.8% (32/410) of cases had multidrug-resistant (MDR) acute post-cataract bacterial endophthalmitis.
  • 87.5% (28/32) of cases were caused by gram-negative bacilli (GNB).
  • 12.5% (4/32) of cases were caused by gram-positive cocci (GPC).
  • The mean inflammation score (IS) was 17.34 + 3.96 before treatment.
  • 93.9% (30/32) of patients had light perception to hand motions as their presenting visual acuity (PVA).
  • 9.4% of eyes developed phthisis after treatment.
  • 46.9% of eyes did not improve vision after treatment.
  • 9.4% of eyes had 20/40 vision after treatment.
  • The absolute risk reduction (ARR) with colistin was higher compared to other antibiotics.

Sources:

  • NewsRx LLC, 2025, Findings on Endophthalmitis Reported by Researchers at L.V. Prasad Eye Institute (Clinical and microbiological characteristics of multidrug-resistant acute bacterial endophthalmitis after cataract surgery. Endophthalmitis Management Study...).
  • Journal of India, November 4, 2025, p 5.
  • Lippincott Williams & Wilkins, www.lww.com.
  • Retina, journals.lww.com/retinajournal/pages/default.aspx.