Antimicrobial resistance in post-cataract endophthalmitis: a systematic review on resistance pattern and treatment outcomes
Abstract
PURPOSE: To systematically review the microbiological spectrum, antimicrobial resistance (AMR) patterns, management strategies, and outcomes in culture-positive endophthalmitis, a rare vision-threatening complication of cataract surgery increasingly challenged by resistance.
METHODS: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 1 January 1990 to 30 June 2025. Eligible studies included culture-positive cases of acute Post-Cataract Endophthalmitis reporting antimicrobial susceptibility and outcomes. Data were extracted on organisms, resistance profiles, treatment strategies and visual acuity. Risk of bias was assessed using the ROBINS-I tool.
RESULTS: Six studies (five retrospective, one prospective) from Europe, Asia, and North America met inclusion criteria. Coagulase-negative staphylococci predominated, with frequent methicillin and fluoroquinolone resistance; Staphylococcus, Streptococcus, and Pseudomonas were less common. An Indian cohort described multidrug-resistant Pseudomonas with near-universal resistance to fluoroquinolones, aminoglycosides, and cephalosporins but susceptibility to colistin, piperacillin, and imipenem. While vancomycin remained active against Gram-positive organisms, emerging resistance was reported in the United Kingdom. Visual outcomes varied: tap-and-inject was comparable to early pars plana vitrectomy (PPV), except in Gram-negative infections where PPV…
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