Jp Romanet

Correlation between clinical data and antibiotic resistance in coagulase-negative Staphylococcus species isolated from 68 patients with acute post-cataract endophthalmitis

Coagulase-negative staphylococci (CNS) cause the majority of post-cataract endophthalmitis, which can lead to anatomical and/or functional loss of the eye. This study reports the antibiotic susceptibilities of CNS isolates associated with acute post-cataract endophthalmitis cases and correlates antibiotic resistance with severity and outcome of infection in these patients. Clinical data (initial ocular examination, final prognosis, antibiotic treatment) and the antibiotic susceptibilities of the isolated CNS strains were obtained from 68 patients with post-surgical endophthalmitis recruited during a 7-year period by the FRench Institutional ENDophthalmitis Study (FRIENDS) group. The CNS strains displayed 100% susceptibility to vancomycin, 70% to fluoroquinolones, 83% to fosfomycin, 46% to imipenem and 18% to piperacillin. The most effective antibiotic combinations were fosfomycin plus a fluoroquinolone and imipenem plus a fluoroquinolone, which were considered adequate in 80% and 58% of patients, respectively. Methicillin resistance was significantly associated with older age (p 0.001), diabetes mellitus (p 0.004), absence of fundus visibility (p 0.06), and poor visual prognosis (p 0.03). Resistance to fluoroquinolones was significantly associated with absence of fundus visibility (p 0.05) and diabetes mellitus (p 0.02). This large prospective study demonstrates that methicillin resistance and, to a lesser extent, fluoroquinolone resistance in CNS strains causing postoperative endophthalmitis are both prevalent in France and associated with a poorer visual prognosis. These results emphasize the need for an effective surveillance of this antibiotic resistance and the development of new diagnostic tools for rapid detection for early optimization of antibiotic therapy in endophthalmitis patients.

Diagnostic microbiologique des endophtalmies aiguës

L’etude bacteriologique des endophtalmies permet de caracteriser le spectre bacterien apres un acte chirurgical (chirurgie de la cataracte, chirurgie filtrante…), de survenue aigue, retardee ou d’evolution chronique. Le diagnostic etiologique microbiologique a recemment beneficie des techniques de biologie moleculaire (PCR) afin d’identifier le genome bacterien et/ou fongique dans des echantillons oculaires. Afin d’optimiser la detection des micro-organismes responsables d’endophtalmies, il est preferable de prelever du vitre initialement et d’appliquer sur ce prelevement une culture conventionnelle et une technique de biologie moleculaire (PCR pan-bacterienne par exemple), les deux approches etant complementaires. L’efficacite et la rapidite des nouvelles techniques de diagnostic microbiologique devraient modifier dans l’avenir nos indications therapeutiques.

Endophtalmies aiguës : du germe à la clinique

The clinical presentation of endophthalmitis depends on numerous factors, especially the bacteria involved, which determines the delay of infection, the amount of ocular inflammation, and the final prognosis. Results of epidemiological studies have provided a better understanding of the correlation between bacteria and clinical characteristics. Some clinical signs may help the clinician to suspect a virulent bacterium. Clinical and microbiological factors are essential to guide the therapeutic strategy in patients with acute endophthalmitis.

Progression of visual field in patients with primary open-angle glaucoma (1): Preliminary results

Purpose To evaluate the visual field rate of progression of patients with treated ocular hypertension (OHT) and primary-open angle glaucoma (POAG). Methods From a multicentric database, 441 eyes of 228 patients with treated ocular hypertension or POAG followed up at least 6 years with Humphrey 24.2 Sita-Standard visual field examination at least twice a year were identified. From initial data, eyes were classified in 5 groups: 104 ocular hypertension, 205 early glaucoma (MD>-6dB), 45 moderate glaucoma (MD -6 to -12dB), 41 advanced glaucoma (MD -12 to -18dB) and 46 severe glaucoma (MD<-18dB). Rate of progression during the follow-up period was calculated using the trend analysis of the Guided Progression Analysis software. Results The mean duration of follow-up was 8.4 years. We found a significant positive association between initial MD and rate of progression in early, moderate and advanced glaucoma (p<0.04). Rate of progression was -0.06 dB/year (-0.19 %VFI/year) in eyes with ocular hypertension, -0.24 dB/year (-0.75 %VFI/year) in eyes with early glaucoma, -0.45 dB/year (-1.72 %VFI/year) in moderate glaucoma, -0.54 dB/year (-2.44 %VFI/year) in advanced glaucoma, and -0.45 dB/year (-1.97 %VFI/year) in severe glaucoma. Conclusion In early to advanced stages of glaucoma, the rate of progression worsened as the severity increased, but became smaller in latest stage of the disease.

Pour la pratiqueDiabète, hypertonie oculaire et glaucome: Diabetes, ocular hypertonia and glaucoma

Glaucome et diabete sont tous deux des pathologies chroniques responsables d’atteinte ophtalmologique. Leur relation, notamment le diabete comme facteur de risque de glaucome, a ete etudiee dans de nombreux travaux. Cependant les resultats de ces etudes sont variables, ne retrouvant pas toujours un lien significatif. Apres une revue de la litterature concernant les relations entre diabete et glaucome, cet article aborde le sujet du glaucome neovasculaire, pathologie directement liee aux complications oculaires du diabete.

Diabète, hypertonie oculaire et glaucome

Glaucome et diabete sont tous deux des pathologies chroniques responsables d’atteinte ophtalmologique. Leur relation, notamment le diabete comme facteur de risque de glaucome, a ete etudiee dans de nombreux travaux. Cependant les resultats de ces etudes sont variables, ne retrouvant pas toujours un lien significatif. Apres une revue de la litterature concernant les relations entre diabete et glaucome, cet article aborde le sujet du glaucome neovasculaire, pathologie directement liee aux complications oculaires du diabete.

448 La Superoxyde Dismutase dans le traitement antioxydantt de la DMLA

Objectif Evaluer l’effet protecteur de la Superoxyde dismutase (SOD) orale en prevention secondaire sur le pourcentage de bi-lateralisation de DMLA neovasculaire apres un an de traitement. Materiels et Methodes Etude pilote prospective randomisee en double aveugle. Quarante-sept patients presentant une DMLA neovasculaire unilaterale et une acuite visuelle de l’œil sain > 5/10, ont experimente un traitement par SOD orale – Glisodine ® (groupe b) versus placebo (groupe a) durant un an. Suivi clinique et angiographique trimestriel. La cotation de la maculopathie s’est faite selon l’echelle simplifiee d’AREDS. Resultats A deux ans : 22 patients placebo (groupe a) et 20 patients traites par Glisodine ® (groupe b) sans difference significative de distribution initiale du score AREDS. 28 % de patients du groupe a versus 32 % de patients du groupe b ont presente une neo-vascularisation sur le deuxieme œil. Le score AREDS des deux groupes s’aggrave de facon significative. Le score du groupe traite s’aggrave plus que celui du groupe placebo. Discussion L’inefficacite de la SOD peut etre expliquee soit par un manque de puissance statistique du au faible echantillon des patients soit par un emballement de la chaine anti-oxydante, necessitant d’autres enzymes pour detoxifier definitivement les radicaux libres. Conclusion La SOD parait inefficace dans la prevention secondaire de la DMLA.

Predictive factors of visual outcome in acute post-cataract endophthalmitis

Purpose To study potential clinical and microbiological predictive factors of visual outcome in patients with acute endophthalmitis following cataract surgery. Methods A prospective study included 100 patients in 4 University hospital.Factors related to the cataract surgery, the initial clinical presentation and the microbiological identification were analyzed according to the final visual outcome using univariate and multivariate (logistic regression) analysis. Results 46% out of the patients had a final visual acuity less than or equal to 0.3 logMar (good visual outcome) at 6 months while 10% had only light perceptions. Patients with good visual outcome differed for the duration of cataract surgery, initial visual acuity, the visibility of fundus and the identification of a coagulase negative staphylococcus. In contrast, patients with a poor visual outcome were older, had more cornea oedema and a more important hypopion at the admission, more complications at the time of cataract surgery. Furthermore a bacterium was more frequently identified in this latter group. Multivariate analysis showed that age, complications at the time of cataract surgery, microbiological identification, pars plana vitrectomy were independent predictive factors. Conclusion Factors of visual outcome in acute postcataract endophthalmitis identified in this prospective study were similar to that reported during the Endophthalmitis Vitrectomy Study 10 years ago. As part of the treatment, pars plana vitrectomy is associated with predictive factors of poor visual outcome. Identification of these predictive factors at presentation should allow a better management of patients needed an aggressive treatment.

Microbiological culture and panbacterial PCR yield of diluted or undiluted vitreous from vitrectomy are comparable in acute postsurgery endophthalmitis (FRIENDS group)

Purpose To compare the diagnostic yield of microbiological analysis performed on diluted and undiluted vitreous samples from pars plana vitrectomy in patients with acute postcataract surgery endophthalmitis. Methods Undiluted and diluted vitreous samples were harvested in 34 patients at the beginning of the vitrectomy, among the 57 vitrectomized patients (out of 100 patients presenting with an acute postcataract surgery endophthalmitis) included in the multicenter prospective study FRIENDS (2004-2005). Vitrectomy was performed after one (n=12) or two (n=22) antibiotics intravitreal injections. Each vitreous sample was divided into two parts for conventional culture (Brain Heart Infusion broth) and panbacterial PCR, respectively. Results Microbiological analysis of both undiluted and diluted vitreous allowed a bacterial identification in 28 out of 34 cases (82.3%). Microbiological diagnosis using undiluted vitreous and conventional culture was negative in 32 cases and positive in 2 cases. In one case, there was a discrepancy between undiluted (culture negative) and diluted vitreous (S. epidermidis). Analysis of both undiluted and diluted vitreous using PCR was positive in 28 cases and negative in 6/34 cases. There was a discrepancy between both samples in three cases. Conclusion Microbiological results combining PCR and cultures showed that diluted vitreous analysis may replace analysis of undiluted vitreous. The diluted sampling of vitreous, more easily performed and less iatrogenic, may be recommended when panbacterial PCR is used .

047 Intérêt de l’analyse microbiologique des prélèvements de vitré dilués dans les endophtalmies aiguës

Introduction Habituellement, dans le cadre de l’endophtalmie, les analyses microbiologiques du vitre sont realisees sur des echantillons de vitre pur. Cependant, dans ce contexte, la vitrectomie diagnostique n’est pas un geste anodin, du fait de l’organisation pathologique du vitre et de la visualisation limitee du segment posterieur. Le prelevement de vitre dilue (infusion ouverte) est plus simple. Nous evaluons ainsi l’analyse microbiologique du vitre dilue. Materiels et Methodes La population etudiee est issue de l’etude multicentrique francaise FRIENDS (2004-2005) et inclut 37 patients atteints d’endophtalmie aigue post-operatoire. L’analyse microbiologique a ete realisee par cultures microbiologiques (Brain Heart Infusion, BHI) et Polymerase Chain Reaction (PCR) panbacterienne 16S avec sequencage, sur vitre pur (400 μL) et vitre dilue (dans une seringue de 1,5 ml, apres ouverture de l’infusion). Resultats Les cultures microbiologiques etaient negatives dans 34 cas (92 %) et positives dans 3 cas (8 %). Une discordance etait notee pour 2 cas : un vitre dilue negatif avec vitre pur positif ( Staphylocoque aureus ) et un vitre dilue positif avec vitre pur negatif ( Staphylocoque epidermidis ). La PCR panbacterienne etait positive dans 27 cas (73 %) : 90 % des prelevements de vitre pur et dilue sont concordants ; 4 cas sont discordants (2 vitres dilues negatifs avec vitres purs positifs ( Staphylocoques epidermidis et pneumoniae ), 2 vitres dilues positifs avec vitres purs negatifs (S taphylocoque epidermidis, Proteus vulgaris ). Discussion La discordance de l’analyse microbiologique par PCR ou cultures, entre vitre dilue et vitre pur, est faible. La PCR permet de multiplier par 9 le fait d’obtenir un resultat bacteriologique positif sur l’ensemble de ces prelevements vitreens. Conclusion Ces resultats montrent que la biopsie vitreenne per-vitrectomie realisee dans ce contexte d’endophtalmie aigue, peut etre obtenue a partir de vitre dilue, sans reduire significativement le taux de positivite des analyses microbiologiques