Design: Retrospective multicentre clinical cohort (nine centres, 2012 to 2024)
Population: 305 eyes (261 patients) with culture-positive endogenous endophthalmitis
Primary outcome: Final visual acuity, retinal detachment and enucleation by organism
Effect: Enucleation 27.7% gram-negative (Serratia 85.7%); presenting visual acuity the dominant prognostic factor

Endogenous endophthalmitis seeds the eye from a bloodstream infection, and empirical treatment often starts before the pathogen is known. This 12-year, nine-centre cohort of 305 culture-positive eyes mapped how presentation and outcome differ by organism.

Staphylococcus aureus was commonest (37.7%), followed by fungal (19.3%) and gram-negative (15.4%) infections. Sources and risks tracked the organism: fungal cases had more immunosuppression and injection drug use, gram-negative cases more urinary sources. Outcomes diverged sharply at the severe end: enucleation was highest with gram-negative organisms (27.7%), driven by Serratia (85.7%), while retinal detachment was most frequent with S aureus and streptococci. Across all groups, worse presenting visual acuity was the most consistent predictor of poor final vision. Intraocular cultures were often negative and only partly concordant with blood cultures.

For practice this supports organism-informed thinking: pursue the systemic source, treat a known gram-negative, especially Serratia, as high-risk for globe loss, and lean on blood cultures given the low intraocular yield, while recognising presenting vision largely sets the ceiling on recovery.

Nine-centre, 12-year cohort of 305 culture-positive endogenous endophthalmitis eyes.
Gram-negative organisms had the highest enucleation rate (27.7%), driven by Serratia (85.7%).
Fungal cases linked to immunosuppression and injection drug use; gram-negative to urinary sources.
Worse presenting visual acuity was the most consistent predictor of poor final vision.
Intraocular cultures were often negative, so blood cultures and the systemic source matter.

Why it matters

It lets clinicians anticipate which eyes are most likely to be lost, and where pathogen-directed urgency matters most, before full culture results arrive.

The statistics, in plain English

These are associations from a retrospective cohort, so organism-outcome links guide suspicion rather than prove causation; the low and discordant culture yields mean a negative intraocular culture does not exclude a specific pathogen.