Estudo clínico, epidemiológico e microbiológico dos casos de endoftalmite infecciosa atendidos no Hospital São Geraldo / HC-UFMG

Abstract

INTRODUCTION: The term endophthalmitis is used to characterize an invasive infection affecting the vitreous and/or aqueous humor caused by bacteria or fungi. The mechanism by which the microorganism invades the ocular globe is used for classification, dividing cases into exogenous endophthalmitis—when the pathogen originates from the external environment (post-traumatic) or from the ocular surface (post-ophthalmologic procedures, post-infectious keratitis)—or endogenous endophthalmitis, when the microorganism arises from hematogenous dissemination. The diagnosis of infectious endophthalmitis is clinical and is complemented by cultures of the vitreous and/or aqueous humor, blood cultures, and urine cultures. Treatment of infectious endophthalmitis includes intravitreal antibiotic therapy, pars plana posterior vitrectomy, and, in some cases, systemic antibiotic therapy. OBJECTIVE: To characterize the clinical, microbiological, and epidemiological profile of infectious endophthalmitis cases treated and followed at the Emergency Department of Hospital São Geraldo / HC-UFMG between January 2013 and December 2021. METHODS: Retrospective analysis of medical records identified based on culture results provided by the Hospital Infection Control Committee (CCIH) of HC-UFMG, including patients with infectious endophthalmitis treated at the Emergency Department of HSG/HC-UFMG between January 2013 and December 2021. RESULTS: A total of 93 patients with endophthalmitis were analyzed, most of whom were male (76.34%), with a mean age of 54.8 years. The median time from symptom onset to medical care was 5 days (interquartile range: 2–10 days), with the most common symptoms being ocular pain, conjunctival hyperemia, and reduced visual acuity. The annual distribution of cases varied throughout the study period: 5 (5.3%) in 2013, 12 (12.9%) in 2014, 9 (9.6%) in 2015, 7 (7.5%) in 2016, 14 (15.05%) in 2017, 11 (11.8%) in 2018, 18 (19.3%) in 2019, 7 (7.5%) in 2020, and 10 (10.7%) in 2021. Visual acuity in logMAR was assessed at baseline, with a median of 2.3, and remained unchanged at the end of treatment; visual acuity worsened in 37 cases (39.7%). Most patients, 86 (92.4%), required hospitalization, and 98.9% received intravitreal antibiotics; retinal detachment occurred in 21 cases (22.5%). Pathogens were identified in 38.7% of cases, with bacteria being the most prevalent agents, notably Staphylococcus epidermidis (16.6%), Staphylococcus aureus (11.1%), Pseudomonas aeruginosa (8.3%), Serratia marcescens (8.3%), and Fusarium spp. (11.1%) as the most prevalent fungal agent. None of the isolated bacteria were resistant to the empirically used intravitreal antibiotics; however, 66.6% of Staphylococcus epidermidis isolates showed resistance to ciprofloxacin. CONCLUSION: This study highlights a high prevalence of gram- positive microorganisms and post-accidental trauma and post-surgical etiologies, with a guarded prognosis in many cases. Although intravitreal antibiotics are effective, resistance to ciprofloxacin—frequently used topically and systemically—requires therapeutic adjustments based on regional microbiological surveillance. The importance of early diagnosis, appropriate management, and preventive strategies to reduce disease morbidity is emphasized.