Acute Endophthalmitis in Eyes Treated Prophylactically with Gatifloxacin and Moxifloxacin

Deramo, Vincent A.; Lai, James C.; Fastenberg, David M.; Udell, Ira J.

doi:10.1016/j.ajo.2006.05.044

« Previous Next »American Journal of Ophthalmology
Volume 142, Issue 5 , Pages 721-725.e1, November 2006

Acute Endophthalmitis in Eyes Treated Prophylactically with Gatifloxacin and Moxifloxacin

Vincent A. Deramo, MD
- Department of Ophthalmology, North Shore–Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York
- Long Island Vitreoretinal Consultants, Great Neck, New York.
- Inquiries to Vincent A. Deramo, MD, 600 Northern Blvd., #216, Great Neck, NY 11021
James C. Lai, MD
- Department of Ophthalmology, North Shore–Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York
- Long Island Vitreoretinal Consultants, Great Neck, New York.
David M. Fastenberg, MD
- Department of Ophthalmology, North Shore–Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York
- Long Island Vitreoretinal Consultants, Great Neck, New York.
Ira J. Udell, MD
- Department of Ophthalmology, North Shore–Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York

Accepted 25 May 2006. published online 13 July 2006.

Purpose

To study the use of prophylactic fourth-generation fluoroquinolone antibiotics, gatifloxacin and moxifloxacin, and bacterial sensitivity in cases of acute postoperative endophthalmitis following cataract surgery.

Design

Retrospective, consecutive, observational case series.

Methods

Forty-two eyes of 42 patients with acute endophthalmitis occurring within six weeks after cataract surgery were identified. All patients were seen in a referral vitreoretinal practice over a two-year time interval. The number of patients using prophylactic gatifloxacin or moxifloxacin and results of bacterial culture and sensitivity to all fluoroquinolone antibiotics were recorded.

Results

Thirty-one of 42 eyes (74%) were treated with perioperative gatifloxacin or moxifloxacin and 24 eyes (57%) were continuously taking one of these antibiotics at the time of diagnosis. Nineteen eyes (45%) had a positive bacterial culture. The most frequent organism isolated was coagulase-negative Staphylococcus. Sensitivities were performed for 14 gram-positive organisms, and sensitivities to ciprofloxacin (50%), ofloxacin (44%), levofloxacin (46%), gatifloxacin (38%), and moxifloxacin (38%) were noted. Five organisms were resistant to gatifloxacin and moxifloxacin with a minimum inhibitory concentration of 8 μg/ml. All gram-positive organisms were sensitive to vancomycin. Median visual acuity improved from hand motions to 20/40 at last follow-up.

Conclusion

Acute endophthalmitis can develop after cataract surgery despite the prophylactic use of fourth-generation fluoroquinolone antibiotics. Gram-positive organisms causing acute endophthalmitis are frequently resistant to all fluoroquinolones, including a significant number of cases resistant to gatifloxacin and moxifloxacin.