Impact Of Cefuroxime Prophylaxis On The Bacterial Spectrum Of Postcataract Surgery Endophthalmitis
Published 2026 - 44th Congress of the ESCRS
Reference: FP20.01 | Type: Free paper | DOI: 10.82333/dpd1-9620
Authors: Dr André Baudère* 1 , A/Prof. Max Maurin 2 , A/Prof. Corinne Dot 3 , Dr Benjamin Matagrin 3 , Dr Mathilde Gallice 1 , A/Prof. Karine Palombi 1 , A/Prof. Christophe Chiquet 4
1Ophthalmology,University Hospital of Grenoble Alpes,Grenoble,France, 2Bacteriology,University Hospital of Grenoble Alpes,Grenoble,France;CNRS TIMC,University of Grenoble-Alpes,Grenoble,France, 3Ophthalmology,University Hospital E. Herriot,Lyon,France, 4Ophthalmology,University Hospital of Grenoble Alpes,Grenoble,France;INSERM U1300, HP2 Laboratory,3. University of Grenoble-Alpes,Grenoble,France
Purpose
To compare the bacterial spectrum, antimicrobial resistance profiles, and clinical severity of acute postcataract endophthalmitis before and after the systematic nationwide adoption of intracameral cefuroxime prophylaxis.
Setting
Multicenter retrospective cohort study conducted at two French university hospitals (Grenoble and Lyon) of the French Institutional Endophthalmitis Study group (FRIENDS). Two cohorts were compared: an early cohort (March 2002–November 2007, no cefuroxime prophylaxis) and a recent cohort (January 2016–February 2025, systematic intracameral cefuroxime prophylaxis).
Methods
234 cases of acute postcataract endophthalmitis were analyzed (early cohort: n=126; recent cohort: n=108). Aqueous humor and vitreous fluid were sampled for conventional culture and panbacterial 16S-PCR. Antimicrobial susceptibility testing (AST) was performed using automated systems (Vitek II, Phoenix), interpreted according to CA-SFM/EUCAST guidelines. Primary outcomes were pathogen distribution and antimicrobial susceptibility profiles. Secondary outcome was clinical presentation severity. Statistical analysis used chi-square tests and Student's t-tests (p<0.05).
Results
Bacterial identification decreased from 67.5% to 58.3%. Coagulase-negative staphylococci (CNS) declined from 38% to 25%, while Enterococcus faecalis increased 5-fold (2% to 10%) and Gram-negative bacteria doubled (3.1% to 7.3%). Cefuroxime resistance rose significantly from 26.0% (13/50) to 66.1% (37/56) of tested isolates. Methicillin resistance in staphylococci increased from 30.3% to 75.0%, and multidrug-resistant CNS phenotypes from 3.0% to 37.5%. All Gram-positive isolates remained vancomycin-susceptible. Clinical presentations were milder: VA ≥20/400 in 29% vs 11.2%, pars plana vitrectomy in 51.9% vs 63.5%.
Conclusions
This comparative cohort study demonstrated a significant shift in the bacterial spectrum following the implementation of routine intracameral cefuroxime prophylaxis, with a decreased prevalence of coagulase-negative staphylococci and increased isolation of Enterococcus faecalis. Antimicrobial resistance, including resistance to cefuroxime and methicillin, increased in the cefuroxime cohort. These findings highlight the need for ongoing surveillance and consideration of alternative and/or complementary prophylactic strategies.