Microbiological sampling has limited value in managing acute postoperative bacterial endophthalmitis: a multicentre study in the UK
Microbiological sampling has limited value in managing acute postoperative bacterial endophthalmitis: a multicentre study in the UK
Aims: to determine whether microbiological testing impacts clinical management in acute postoperative endophthalmitis. Methods: Multicentre retrospective cohort study encompassing five tertiary centres in the UK. Patients presenting with acute postoperative endophthalmitis with at least 4 weeks follow-up were included. The main outcome was the proportion with a change in management (defined as further intravitreal antibiotic therapy and/or further surgical intervention within 4 weeks of the initial treatment) and the rationale for this change.
Results: 190 eyes of 189 patients were included. Patients presented at a median of 5 days postoperatively (IQR 3-10). Sampling was predominantly obtained via vitreous tap alone (80/190, 42%) or with both vitreous and anterior chamber tap (84/190, 44%). Over half were culture-positive (107/190, 56%), and only bacterial pathogens were isolated. Culture-positive cases with available antibiotic sensitivity data demonstrated in vitro sensitivity to at least one of the empirical intravitreal antibiotics administered. Seventy-six eyes (40%) had a change in management within 4 weeks of the initial treatment. These additional procedures took place within 48 hours of initial treatment in 46% (35/76) of patients. The main reasons were a lack of clinical improvement (46/76, 61%) or clinical deterioration (18/76, 24%); none of these changes were prompted or guided by culture or sensitivity results.
Conclusions: microbiological sampling was of limited clinical utility in this series. In patients presenting with suspected acute bacterial endophthalmitis, if microbiological sampling might pose any delays to treatment, consideration should be given to immediate intravitreal antibiotic treatment without sampling to optimise visual outcomes.
Endophthalmitis, Intravitreal antibiotics, Microbiology, Multicentre, Pars plana vitrectomy, Vitreous tap
Ong, Ariel Yuhan
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Teh, Boon Lin
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Milligan, Alice
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Thomas, Alice
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Flores-Sánchez, Blanca
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Hoang, Vy
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Fingret, Jacob M.
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Mehta, Ankur
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Lotery, Andrew J.
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Smith, Jonathan
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Garcia-Cabrera, Raquel
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Pavesio, Carlos
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Steel, David H.
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Charbel Issa, Peter
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Ong, Ariel Yuhan
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Teh, Boon Lin
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Milligan, Alice
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Thomas, Alice
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Flores-Sánchez, Blanca
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Hoang, Vy
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Fingret, Jacob M.
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Mehta, Ankur
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Lotery, Andrew J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Smith, Jonathan
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Garcia-Cabrera, Raquel
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Pavesio, Carlos
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Steel, David H.
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Charbel Issa, Peter
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Ong, Ariel Yuhan, Teh, Boon Lin, Milligan, Alice, Thomas, Alice, Flores-Sánchez, Blanca, Hoang, Vy, Fingret, Jacob M., Mehta, Ankur, Lotery, Andrew J., Smith, Jonathan, Garcia-Cabrera, Raquel, Pavesio, Carlos, Steel, David H. and Charbel Issa, Peter
(2025)
Microbiological sampling has limited value in managing acute postoperative bacterial endophthalmitis: a multicentre study in the UK.
British Journal of Ophthalmology.
(doi:10.1136/bjo-2025-327543).
Abstract
Aims: to determine whether microbiological testing impacts clinical management in acute postoperative endophthalmitis. Methods: Multicentre retrospective cohort study encompassing five tertiary centres in the UK. Patients presenting with acute postoperative endophthalmitis with at least 4 weeks follow-up were included. The main outcome was the proportion with a change in management (defined as further intravitreal antibiotic therapy and/or further surgical intervention within 4 weeks of the initial treatment) and the rationale for this change.
Results: 190 eyes of 189 patients were included. Patients presented at a median of 5 days postoperatively (IQR 3-10). Sampling was predominantly obtained via vitreous tap alone (80/190, 42%) or with both vitreous and anterior chamber tap (84/190, 44%). Over half were culture-positive (107/190, 56%), and only bacterial pathogens were isolated. Culture-positive cases with available antibiotic sensitivity data demonstrated in vitro sensitivity to at least one of the empirical intravitreal antibiotics administered. Seventy-six eyes (40%) had a change in management within 4 weeks of the initial treatment. These additional procedures took place within 48 hours of initial treatment in 46% (35/76) of patients. The main reasons were a lack of clinical improvement (46/76, 61%) or clinical deterioration (18/76, 24%); none of these changes were prompted or guided by culture or sensitivity results.
Conclusions: microbiological sampling was of limited clinical utility in this series. In patients presenting with suspected acute bacterial endophthalmitis, if microbiological sampling might pose any delays to treatment, consideration should be given to immediate intravitreal antibiotic treatment without sampling to optimise visual outcomes.
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2025-07 Microbiological sampling has limited value in managing acute postoperative endophthalmitis
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Accepted/In Press date: 8 June 2025
e-pub ahead of print date: 9 July 2025
Keywords:
Endophthalmitis, Intravitreal antibiotics, Microbiology, Multicentre, Pars plana vitrectomy, Vitreous tap
Identifiers
Local EPrints ID: 506535
URI: http://eprints.soton.ac.uk/id/eprint/506535
ISSN: 0007-1161
PURE UUID: 21763115-51b0-4c17-b1d3-6d259946b0d6
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Date deposited: 11 Nov 2025 17:36
Last modified: 12 Nov 2025 02:37
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Contributors
Author:
Ariel Yuhan Ong
Author:
Boon Lin Teh
Author:
Alice Milligan
Author:
Alice Thomas
Author:
Blanca Flores-Sánchez
Author:
Vy Hoang
Author:
Jacob M. Fingret
Author:
Ankur Mehta
Author:
Jonathan Smith
Author:
Raquel Garcia-Cabrera
Author:
Carlos Pavesio
Author:
David H. Steel
Author:
Peter Charbel Issa
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