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Polymicrobial endophthalmitis: prevalence, causative organisms, and visual outcomes

Animesh Jindal1, Mayur R Moreker2, Avinash Pathengay1*, Manav Khera1, Subhadra Jalali2, Ajit Majji2, Annie Mathai2, Savitri Sharma3, Taraprasad Das3 and Harry W Flynn4

Author Affiliations

1 LV Prasad Eye Institute, GMRV Campus, Visakhapatnam, India

2 LV Prasad Eye Institute, KAR Campus, Hyderabad, India

3 Bhubaneswar Eye Institute, LV Prasad Eye Institute, Bhubaneswar, India

4 Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

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Journal of Ophthalmic Inflammation and Infection 2013, 3:6  doi:10.1186/1869-5760-3-6

Published: 7 January 2013



The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the non-comparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010.


Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200.


Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

Polymicrobial; Endophthalmitis; Antibiotic susceptibilities