it can be classified into two broad categories : acute - onset and delayed - onset . according to endophthalmitis vitrectomy study , infection occurring within 6 weeks
after cataract surgery was defined as acute - onset and after 6 weeks as delayed - onset.1 these two categories differ in their microbiological spectrum.2 the purpose of the current study was to investigate the spectrum of organisms causing culture proven delayed post - cataract surgery endophthalmitis and their antimicrobial susceptibilities at our center between 2006 and 2013 and compare it with available western literature .
microbiology records were reviewed of all the culture proven delayed post - cataract surgery endophthalmitis cases treated at l v prasad eye institute , hyderabad , india between january 2006 and march 2013 .
the study was approved by the institutional review board and adhered to the guidelines of the declaration of helsinki .
vitreous samples from all patients had been investigated for bacteria and fungus using institutional protocol .
bacterial isolates were identified using analytical profile index system until 2010 and vitek-2 compact system ( biomrieux , craponne , france ) , thereafter .
isolates included 12 ( 36.4% ) gram - positive cocci , one ( 3.0% ) gram - positive bacilli , seven ( 21.2% ) gram - negative bacteria , two ( 6.1% ) nocardia sp . , and eleven ( 33.3% ) fungi ( table 1 ) .
most common isolates identified were coagulase negative staphylococci , aspergillus sp . and candida sp .
( 5/33 , 15.2% each ) followed by streptococcus pneumoniae ( 3/33 , 9.1% ) and burkholderia cepacia ( 3/33 , 9.1% ) .
onset of endophthalmitis occurred 30 days to 15 years ( median 150 days ) post - operatively in streptococcal cases , 30 to 168 ( median 72 ) days in coagulase - negative staphylococcal cases , 60 to 157 ( median 84 ) days in gram - negative cases , and 60 to 365 ( median 76 ) days in fungal cases .
gram - negative isolates were most susceptible to ofloxacin ( 85.7% ) followed by ceftazidime , ciprofloxacin , gatifloxacin , and moxifloxacin ( 71.4% each ) .
isolates included 12 ( 36.4% ) gram - positive cocci , one ( 3.0% ) gram - positive bacilli , seven ( 21.2% ) gram - negative bacteria , two ( 6.1% ) nocardia sp . , and eleven ( 33.3% ) fungi ( table 1 ) .
most common isolates identified were coagulase negative staphylococci , aspergillus sp . and candida sp .
( 5/33 , 15.2% each ) followed by streptococcus pneumoniae ( 3/33 , 9.1% ) and burkholderia cepacia ( 3/33 , 9.1% ) .
onset of endophthalmitis occurred 30 days to 15 years ( median 150 days ) post - operatively in streptococcal cases , 30 to 168 ( median 72 ) days in coagulase - negative staphylococcal cases , 60 to 157 ( median 84 ) days in gram - negative cases , and 60 to 365 ( median 76 ) days in fungal cases .
gram - negative isolates were most susceptible to ofloxacin ( 85.7% ) followed by ceftazidime , ciprofloxacin , gatifloxacin , and moxifloxacin ( 71.4% each ) .
the microorganisms in delayed post - cataract surgery endophthalmitis are believed to be less virulent as indicated by its insidious onset and low grade of inflammation . in most of the studies published in the literature ,
propionibacterium acnes were most commonly isolated from the vitreous samples of delayed - onset endophthalmitis.25 in the current study , p. acnes were not isolated from any sample .
one of the reasons for this could be that anaerobic culture was not done in all cases . from india
, there are mostly case reports on delayed - onset endophthalmitis after cataract surgery,6 thus it is not possible to comment on the incidence of p. acnes associated delayed post - cataract surgery endophthalmitis in this region . a higher incidence of fungal isolates noted in the current study is consistent with other studies from the same geographic region.2 fungi ,
comparison of microorganisms identified in various delayed - onset post - cataract surgery endophthalmitis studies is given in table 2 .
the antimicrobial susceptibility of the organisms is comparable to that of the same organisms in different clinical settings like acute post - cataract endophthalmitis and post - traumatic endophthalmitis in the same geographic region.7,8 gram - positive organisms are most susceptible to vancomycin and gram - negative organisms to fluoroquinolones and ceftazidime .
low susceptibility of gram - negative organisms to amikacin was due to b. cepacia being the most common cause and they have been shown to be less susceptible to amikacin as compared to ceftazidime and ciprofloxacin.9 this is the first study from india on the antimicrobial spectrum and antimicrobial susceptibility of delayed post - cataract surgery endophthalmitis .
less virulent and slow growing organisms like coagulase negative staphylococci and fungi are the most common causative agents of delayed - onset endophthalmitis .
 the objective of this study was to evaluate the microbiological spectrum and antimicrobial susceptibility of isolates in delayed post - cataract surgery endophthalmitis . 
 a retrospective review of 33 consecutive patients with culture proven delayed post - cataract surgery endophthalmitis was done from january 2006 to march 2013 . 
 there were 22 bacterial and eleven fungal cases . 
 common isolates were streptococci ( seven cases ) , coagulase - negative staphylococci ( five ) , gram - negative bacilli ( seven ) , nocardia ( two ) , aspergillus ( five ) , candida ( five ) . 
 gram - positive cocci were most susceptible to vancomycin and gatifloxacin ( 91.7% ) . 
 gram - negative isolates were most susceptible to ofloxacin ( 85.7% ) . 
 fungi being slow growing organisms are an important cause of delayed post - cataract surgery endophthalmitis . 
Introduction
Methods
Results
Microbial spectrum
Antimicrobial susceptibility
Discussion