Endophthalmitis Caused by Enterococcus faecalis: Clinical Features, Antibiotic Sensitivities, and Outcomes

PurposeTo report the clinical features, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis.Study DesignRetrospective, observational case series.MethodsA consecutive case series of patients with culture-positive endophthalmitis caused by E. faecalis between January 1, 2002, and December 31, 2012, at an academic referral center.ResultsOf 14 patients identified, clinical settings included bleb association (n = 8), occurrence after cataract surgery (n = 4), and occurrence after penetrating keratoplasty (n = 2). All isolates were vancomycin sensitive. When comparing isolates in the current study with isolates from 1990 through 2001, the minimal inhibitory concentration required to inhibit 90% of isolates increased for ciprofloxacin (4 μg/mL from 1 μg/mL), erythromycin (256 μg/mL from 4 μg/mL), and penicillin (8 μg/mL from 4 μg/mL), indicating higher levels of resistance. The minimal inhibitory concentration required to inhibit 90% of isolates remained the same for vancomycin (2 μg/mL) and linezolid (2 μg/mL). Presenting visual acuity ranged from hand movements to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 12) and pars plana vitrectomy with intravitreal antibiotic injection (n = 2). Visual acuity outcomes were 20/400 or worse in 13 (93%) of 14 patients.ConclusionsAlthough all isolates were sensitive to vancomycin and linezolid, higher minimal inhibitory concentration required to inhibit 90% of isolates in the current study, compared with isolates from 1990 through 2001, occurred with ciprofloxacin, erythromycin, and penicillin. Despite prompt treatment, most patients had poor outcomes.