inflamation session - All India Ophthalmological Society

296 AIOC 2009 PROCEEDINGSphenomenon of response of microbes to theselective pressure of an antimicrobial drug. Insystemic infections the emergence of multidrugresistant strains of Gram-negative bacteria(Pseudomonas, Klebsiella, Enterobacter,Acinetobacter, Salmonella species) and Grampositiveorganisms (Staphylococcus,Enterococcus, Streptococcus species) isworrisome in the present therapeutic scenario. Inendophthalmitis, previous studies haveemphasized the changing trends in the antibioticsusceptibility of the causative organisms.Previous studies have shown that Vancomycinretains in vitro efficacy against more than 99% ofgram-positive bacteria and that Ceftazidime iseffective against 100% of gram-negative bacteriatested. The Indian scenario for antibioticsusceptibility of bacteria causingendophthalmitis is different. In postoperativeendophthalmitis while the Gram-positive isolatesare still 100% susceptible to Vancomycin, amongthe Gram-negative isolates 87.5% are susceptibleto Ciprofloxacin, 82.1% to Amikacin and only60.9% are susceptible to Ceftazidime.Withregards to posttraumatic endophthalmitis, it hasbeen shown that in south India only 66.7% of theGram-negative isolates are susceptible toCeftazidime. A high prevalence of resistance ofthe culture isolates to Vancomycin and Amikacinhas also been noted in other studies from SouthIndia.The present study deals with multidrugresistance in bacteria causing endophthalmitis inSouthern India.To determine the prevalence, type of bacteria andthe visual outcome of culture-provenendophthalmitis caused by multidrug resistant(MDR) bacteria in patients seen at a tertiary eyecare centre in southern India.Materials and MethodsA retrospective review of the clinical andmicrobiological records of culture provenconsecutive patients, clinically diagnosed to havebacterial endophthalmitis between January 2000and December 2007, was done. All patients hadbeen treated according to standard guidelinesand their vitreous aspirates were subjected tomicrobiological work-up that included culturefor bacteria and antimicrobial susceptibilitytesting by Kirby-Bauer disc diffusion assay.Resistance to two or more different groups ofantibiotics was defined as MDR. The bestcorrected visual acuity of < 20/200 at the finalfollow-up was defined as a poor visual outcome.ResultsVitreous from 45 (5.5%) of 807 patients yieldedMDR bacteria in culture. Thirty two (72%) ofthese patients had a poor visual outcome. MDRwas more common in gram-negative bacteria (36;78%) compared to gram-positive (9; 22%).Pseudomonas spp. (25 isolates) was thecommonest isolated bacteria. Fifteen (41 %) of the36 gram-negative isolates were resistant toCeftazidime, 18 (50%) to Amikacin and 11 (31%)of these 36 isolates were resistant to bothAmikacin and Ceftazidime.DiscussionMultidrug resistance is not seen frequently inbacteria causing endophthalmitis. Pseudomonasspp. is the commonest multidrug resistantorganism encountered. The visual outcome in amajority of the cases is poor. Alternative newergroup of drugs may be considered for themanagement of these isolated cases.Incidence of Cystoid Macular Oedema Following Manual SICSusing OCTDr. Dimpy Gothwal, Dr. Triveni Grover, Dr. Amit Grover, Dr. Parul Agarwal,Dr. Harjeet Kaur Sidhu, Dr. Ravindra Nath Bhatnagar(Presenting Author: Dr. Dimpy Gothwal)Ocular tissues, like those of other organs,exhibit well-defined morphologic reactionsto local trauma and insult in the form ofhyperemia, vasodilatation, increasedpermeability of blood vessels, and edema. CMEfollowing cataract surgery is one suchmanifestation and is an important sightthreatening late complication of cataract surgery