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August 1996

The Endophthalmitis Vitrectomy Study

Author Affiliations

Boston, Mass

Arch Ophthalmol. 1996;114(8):1025-1026. doi:10.1001/archopht.1996.01100140233031

The EVS group is to be complimented for undertaking a large multicenter trial to evaluate the role of vitrectomy and intravenous antibiotics in treating bacterial endophthalmitis occurring after cataract extraction or secondary lens implantation surgery.1

However, we believe that no conclusion regarding the value of systemic antibiotics can be drawn from this study, as the antibiotics used (ceftazidime and amikacin) have minimal activity against the organisms most commonly isolated—staphylococci. In this study, 69% of cases had "laboratory-confirmed" positive cultures for organisms. Of these, 68% were due to coagulase-negative staphylococci (47% of all cases). What percentage of these cases were methicillin resistant? In most hospitals, 50% to 80% of coagulase-negative staphylococci are methicillin resistant,2 and as 2 of the EVS authors have previously noted,3 ceftazidime has no activity against such organisms. Indeed, ceftazidime has little activity against any staphylococci, including Staphylococcus aureus; only 15% to 25% of isolates

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