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Purpose  To describe the spectrum of bacterial and fungal pathogens in cases of endophthalmitis requiring evisceration and report their antimicrobial susceptibilities.    Methods  Retrospective, consecutive, and descriptive case series of endophthalmitis that underwent evisceration from January 2004 to December 2017. Vitreous samples from all patients had been investigated for bacteria and fungus using institutional protocol. Bacterial isolates were identified using analytical profile index (API) system until 2010 and Vitek-2 compact system (bioMérieux, France), thereafter. The susceptibility of bacterial isolates to a variety of antibiotics was determined by the Kirby-Bauer disk-diffusion method.    Results  Of 791 cases reviewed, culture positivity was reported in 388 cases (48.92%). Commonest clinical setting of endophthalmitis necessitating evisceration was post-microbial keratitis (58%), followed by post-trauma and post-cataract surgery (14–15%). The commonest isolate was  Streptococcus pneumoniae , seen in 68 samples overall (17.52%). One hundred and eighty-three isolates (47.16%) were gram-positive, 86 (22.16%) were gram-negative, and fungi constituted 137 (35.3%) isolates.  Streptococcus pneumoniae  was the commonest gram-positive bacterial isolate seen in 68/183 samples (37.15%). Among gram-negative organisms, the commonest was  Pseudomonas aeruginosa  seen in 47/86 (54.65%).  Aspergillus  spp. formed the commonest fungal isolate, 58/137 (42.33%). The susceptibility of the gram-positive bacteria was highest with vancomycin, 136/147 (92.51%) and for gram-negative bacteria was seen best with imipenem 24/29 (82.75%). Susceptibility to ceftazidime was 31/61 (50.81%) in 31/61.    Conclusion  Endophthalmitis due to  Pneumococci, Aspergillus , and  Pseudomonas  can be very fulminant and progress to require evisceration in spite of prompt and appropriate treatment.

Infectious endophthalmitis leading to evisceration: spectrum of bacterial and fungal pathogens and antibacterial susceptibility profile