Post-cataract endophthalmitis became more enterococcal and more cefuroxime-resistant

Design

Retrospective comparative cohort, two periods

Population

234 eyes with acute post-cataract endophthalmitis at 2 French referral centres (2002–2007 vs 2016–2025)

Primary outcome

Pathogen distribution, cefuroxime and methicillin resistance, clinical severity

Effect

Cefuroxime resistance 26.0% → 66.1% (aOR 3.75, 1.59–8.82); MRS 30.3% → 75.0% (aOR 6.75, 1.99–22.83); E. faecalis 2% → 10%

Intracameral cefuroxime is the default prophylaxis for cataract surgery in much of the world. This retrospective French comparison studied 234 eyes with acute endophthalmitis within six weeks of cataract surgery at two referral centres, in 2002–2007 (126) and 2016–2025 (108), using cultures and 16S PCR.

Organisms were identified in 67.5% and 58.3% of eyes. Coagulase-negative staphylococci fell from 38% to 25% of isolates, while Enterococcus faecalis rose from 2% to 10% and Gram-negative bacteria from 3.1% to 7.3%. Cefuroxime resistance rose from 26.0% to 66.1% of tested isolates (adjusted OR 3.75, 1.59 to 8.82); methicillin resistance among staphylococci from 30.3% to 75.0% (OR 6.75, 1.99 to 22.83); multidrug resistance from 3.0% to 37.5%. Recent cases presented less severely, with vision of 20/400 or better in 29.0% vs 11.2%.

The shift is toward organisms that cefuroxime does not cover — enterococci are intrinsically resistant — so empirical intravitreal treatment must cover them, and prophylaxis choices deserve local review. Many Indian centres use intracameral moxifloxacin, whose coverage of enterococci and resistant staphylococci is also imperfect. Local microbiology, not habit, should decide.

• Take aqueous and vitreous samples for culture and PCR in every suspected post-cataract endophthalmitis before injecting antibiotics.
• Use intravitreal vancomycin with ceftazidime as empirical treatment; it covers methicillin-resistant staphylococci and enterococci.
• Review your unit's endophthalmitis isolates and resistance pattern annually and adjust intracameral prophylaxis accordingly.
• Do not assume intracameral cefuroxime or moxifloxacin covers enterococci.
• Report every case to a regional or institutional surveillance register.

Why it matters

The organisms now causing endophthalmitis are increasingly the ones standard prophylaxis does not cover.

Don't overread it

Two French centres with incomplete susceptibility data; resistance patterns differ by country and must be checked locally.

The statistics, in plain English

The resistance rates are percentages of isolates tested, not of all cases, and not every isolate was tested — so the true proportions are uncertain. The direction of change is consistent across several measures.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.