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Diagnostic performance of blood culture bottles for vitreous culture compared to conventional microbiological cultures in patients with suspected endophthalmitis

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Abstract

The purpose of this investigation was to evaluate the performance of blood culture bottles in comparison to conventional microbiological culture techniques in detecting causative microorganisms of endophthalmitis and to determine their anti-infective susceptibility profiles. All consecutive cases with clinically suspected endophthalmitis in a university-based ophthalmology department between January 2009 and December 2016 were analysed in this retrospective comparative case series. Samples from 247 patients with suspected endophthalmitis underwent microbiological diagnostic work-up. All three culture methods were performed from 140 vitreous specimens. Vitreous fluid specimens were inoculated in blood culture bottles, aerobic and anaerobic broth solutions, and on solid media. Anti-infective susceptibility profiles were evaluated by semi-automated methods and/or gradient diffusion methods. Microorganisms were grown in 82 of 140 specimens for which all methods were performed (59%). Microorganisms were more frequently grown from blood culture bottles (55%) compared to broth solution (45%, p = 0.007) and solid media (33%, p < 0.0001). Considerable differences in the performance among culture media were detected for fungal pathogens. All grown fungi were detected by blood culture bottles (11 of 11, 100%). Broth solution recovered 64% and solid media 46% of grown fungi. No Gram-positive bacterium was resistant to vancomycin and all Gram-negative pathogens except for one isolate were susceptible to third-generation cephalosporins. In suspected endophthalmitis patients, blood culture bottles have a higher overall pathogen detection rate from vitreous fluid compared to conventional microbiological media, especially for fungi. The initial intravitreal antibiotic therapy with vancomycin plus third-generation cephalosporins appears to be an appropriate treatment approach for bacterial endophthalmitis.

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Authors and Affiliations

  1. Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany

    Jan Kehrmann, Valerie Chapot, Jan Buer & Joerg Steinmann

  2. Department of Ophthalmology, University Hospital Essen, Essen, Germany

    Philipp Rating & Norbert Bornfeld

  3. Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany

    Joerg Steinmann

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  1. Jan Kehrmann
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  2. Valerie Chapot
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  3. Jan Buer
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  4. Philipp Rating
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  5. Norbert Bornfeld
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  6. Joerg Steinmann
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Correspondence to Jan Kehrmann or Joerg Steinmann.

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The authors declare that they have no conflict of interest.

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All samples were taken as a part of standard care procedures; therefore, no written informed consent was necessary for this type of study. The recommendations of the ICH-GCPC guidelines have been followed and the study was performed in accordance with the latest version of the Declaration of Helsinki.

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Kehrmann, J., Chapot, V., Buer, J. et al. Diagnostic performance of blood culture bottles for vitreous culture compared to conventional microbiological cultures in patients with suspected endophthalmitis. Eur J Clin Microbiol Infect Dis 37, 889–895 (2018). https://doi.org/10.1007/s10096-017-3182-6

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  • DOI: https://doi.org/10.1007/s10096-017-3182-6

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