Abstract:

Objective

The aim of this study is to investigate the distribution of pathogenic bacteria and the influencing factors of prognosis of infectious endophthalmitis in Shanxi Province.

Methods

The clinical data of 412 patients（412 eyes）with infectious endophthalmitis diagnosed at Department of Keratology of Shanxi Eye Hospital from 2011 to 2024 were selected.Among them，there were 318 males（318 eyes）and 94 females（94 eyes）with an average age of（52.1±19.4）years（ranging from 1 to 86 years）.Peripheral blood white blood cell count（WBC），neutrophil absolute value（NEUT＃）and peripheral blood neutrophil absolute value-lymphocyte absolute value（NLR）were described by median and upper and lower quartiles when the measurement data did not conform to the normal distribution.Non-parametric test Mann-Whitney U test was used for comparison between groups.The data on number of bacterial strains and cause of disease，the distribution，and the drug resistance rate of pathogenic bacteria，strabismus，presence of foreign bodies，residual conditions，retinal detachment，presence of trauma，and time of visit were expressed as the number of cases and percentages and compared using chi-square test between groups.

Results

There were 43 cases（43 eyes），296 cases（296 eyes）and 73 cases（73 eyes）in 1 to≤14 years old，＞14 to≤65 years old and ＞65 to 86 years old，accounting for 10.4%，71.8% and 17.7%，respectively.The main pathogens were Streptococcus，Staphylococcus epidermidis and Staphylococcus epidermidis.Among 412 cases（412 eyes）with infectious endophthalmitis，283 cases（283 eyes）were traumatic endophthalmitis，and 126 cases（126 eyes）were infected by intraocular surgery，accounting for 68.7% and 30.6%，respectively.Prognostic visual acuity was≥0.1 in 151 cases（151 eyes）and＜0.1 in 261 cases（261 eyes），accounting for 36.6%，63.4%.Among the patients with infectious endophthalmitis，there were 331 strains of gram-positive bacteria，78 strains of gram-negative bacteria and 3 strains of fungi，respectively，accounting for 80.3%，18.9% and 0.7%，respectively.Among them，Staphylococcus epidermidis and Streptococcus were the main gram-positive bacteria，accounting for 47.3%and 22.2%，respectively；gram-negative bacteria were mainly Pseudomonas aeruginosa，accounting for 17.9%.The main pathogenic bacteria of traumatic endophthalmitis was Staphylococcus epidermidis，accounting for 49.1%.The median and quartile of WBC，NEUT＃and NLRin patients with visual acuity≥0.1 were 6.77（6.19，7.76）×10⁹/L，5.11（3.24，5.49）×10⁹/L and 3.75（3.13，4.49）×10⁹/L，respectively；those of patients with prognostic visual acuity＜0.1 were 9.21（7.83，9.93）×10⁹/L，5.52（5.01，6.01）×10⁹/L and 4.29（3.88，4.88）×10⁹/L.There was a statistically significant difference between them（Z＝-11.563，-6.562，-5.323；P＜0.05）.There were 77 cases（77 eyes）with prognostic visual acuity≥0.1 in the right eye，92 cases（92 eyes）with visiting time≥24 h，88 cases（88 eyes）with trauma and 141 cases（141 eyes）with initial visual acuity ＜0.1，5 cases（5 eyes）with residual foreign body and 11 cases（11 eyes）with retinal detachment，accouting for 51.0%，60.9%，58.3%，93.4%，3.3% and 7.3%；the prognosis of patients with visual acuity＜0.1 were 136 cases（136 eyes），192 cases（192 eyes），195 cases（195 eyes），255 cases（255 eyes），13 cases（13 eyes）and 50 cases（50 eyes），respectively，accouting for 52.1%，73.6%，74.7%，97.7%，5.0% and 19.2%.There were significant differences in the initial visual acuity，treatment time，retinal detachment and trauma between the groups（χ²＝0.029，0.008，0.001，0.001；P＜0.05）.

Conclusions

Infectious endophthalmitis in Shanxi Province is mainly traumatic endophthalmitis，and the pathogenic bacteria are mainly Staphylococcus epidermidis.The incidence of infectious endophthalmitis after ocular rupture is high.WBC，NEUT＃，NLR，initial visual acuity，visiting time，retinal detachment and trauma were the influencing factors of visual prognosis.

Key words: Endophthalmitis, Pathogenic factors, Etiology analysis, Prognosis