Design: Retrospective multicentre cohort, nine US academic centres
Population: 305 eyes of 261 patients with culture-positive endogenous endophthalmitis, 2012–2024
Primary outcome: Final visual acuity, retinal detachment, enucleation
Effect: Blood culture positive 66% vs vitreous 31%; enucleation 27.7% with gram-negative organisms

A retrospective cohort from nine US academic centres, published in the American Journal of Ophthalmology on 26 September, reviewed 305 eyes of 261 patients with culture-positive endogenous endophthalmitis between 2012 and 2024.

Staphylococcus aureus caused 38%, fungi 19%, gram-negative organisms 15% and streptococci 13%. Blood cultures were positive in 66% of eyes, vitreous in 31% and aqueous in only 9%; where both were taken, blood and eye cultures agreed in 62%. Fungal cases were linked to immunosuppression and injecting drug use; gram-negative cases often had a urinary source. Worse presenting vision was the most consistent predictor of poor final vision. Enucleation was most frequent with gram-negative infection (28%), and particularly Serratia.

The low intraocular culture yield means blood cultures and a search for the systemic source are central to choosing therapy.

Take blood cultures in every suspected endogenous endophthalmitis; they were positive twice as often as vitreous.
Search for the source — endocarditis, urinary tract, liver abscess, lines, injecting drug use.
Treat gram-negative infection, especially Serratia, as high risk for loss of the eye.
Consider fungal infection in immunosuppressed patients and people who inject drugs.

Why it matters

It shows why ophthalmologists and physicians need to manage these patients together from the start.

The statistics, in plain English

Percentages for organism groups describe this referral cohort and will differ in settings such as India, where Klebsiella liver abscess and fungal cases may be commoner. The Serratia figure is based on a small number of eyes.