AUTHOR AND EDITOR INFORMATION

Section 1 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

INTRODUCTION

Section 2 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Background

The genus Escherichia is named after Theodor Escherich who isolated the type species of the genus in 1885. Escherichia coli is a gram-negative rod that is found as a normal commensal in the GI tract, which can produce ocular infection including corneal ulcer and endophthalmitis, which can result in a devastating outcome. Early recognition and appropriate treatment is crucial. These infections most commonly occur in patients who are debilitated, immunocompromised, or diabetic or in corneas with an underlying pathologic condition.

Pathophysiology

E coli is rarely found in the normal flora of the conjunctiva. It most commonly is seen as a source of infection in ophthalmia neonatorum. E coli endophthalmitis is a rare complication of E coli septicemia. Antimicrobial resistance occurs through plasmid-mediated determinants. These multiresistant plasmids can be transferred by conjugation. It has a poor prognosis, and early diagnosis and treatment are essential to retain useful vision.

These infections most commonly occur in patients who are debilitated, immunocompromised, or diabetic or in corneas with an underlying pathologic condition. Exogenous endophthalmitis usually is associated with trauma or intraocular surgery. In endogenous endophthalmitis, urinary track infection was the most common primary site of infection and nearly all patients are diabetic.

Early recognition and appropriate treatment is crucial, since E coli endophthalmitis has an extremely poor prognosis. Depending on the severity, most patients need aggressive management and early medical and surgical intervention.

Frequency

United States

Approximately 5-10% of endogenous bacterial endophthalmitis is due to E coli. Exogenous endophthalmitis associated with intraocular surgery is 0.1-0.5%. Of these infections, E coli is rare a cause.

Endophthalmitis occurs following 2-7% of penetrating injuries. Incidence is higher in association with intraocular foreign body. Of these infections, E coli is a rare cause.

International

International frequency is unknown.

Mortality/Morbidity

In endophthalmitis, the course of illness is very rapid, and complete destruction of intraocular tissues occurs. Corneal infection due to E coli produce indolent corneal ulcers with poor prognosis because most of these patients of have an underlying immunocompromised disorder or have abnormal corneal surface with compromised protective barrier.

Sex

Men are 4 times more likely to have ocular trauma than women, which may lead to bacterial endophthalmitis. For corneal ulcer due to E coli, no difference exists in frequency between the sexes.

Age

E coli may be seen as a source of infection in ophthalmia neonatorum in neonates. Also, endophthalmitis may occur in neonates following meningitis. However, almost all cases of E coli endophthalmitis have been in adults with an immunocompromised state or with diabetes.

CLINICAL

Section 3 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

History

• Past ocular history
• • Previous eye injury
  • Infection
  • Surgery
  • Diabetic eye disease
• Past medical history
• • Diabetes
  • Immunocompromised host
  • Intravenous drug abuser
  • Urinary tract infection
• Visual complaints
• • Decreased vision
  • Eyelid edema
  • Diplopia red eye
  • Mild-to-severe ocular pain
  • Photophobia
  • Discharge

Physical

• Signs
• • Focal white opacity in the corneal stroma
  • Epithelial defect that stains fluorescent
  • Stroll edema and inflammation surrounding the infiltrate
  • Conjunctival injection
  • Corneal thinning
  • Anterior chamber reaction
  • Hypopyon
  • Mucopurulent discharge
  • Upper eyelid edema
  • Posterior synechiae
  • Hyphema
  • Glaucoma

Causes

• Exogenous causes
• • Immunocompromised state
  • Irregular corneal epithelium
  • Trauma
  • Ocular surgery
• Endogenous causes
• • Urinary tract infection
  • Endocarditis
  • Meningitis
  • Systemic infection

DIFFERENTIALS

Section 4 of 11  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Other Problems to be Considered

Anterior segment involvement
Bacterial corneal ulcer
Fungal corneal ulcer (eg, following trauma)
Acanthamoeba corneal ulcer
Viral corneal ulcer (eg, herpes simplex, herpes zoster)
Atypical mycobacteria corneal ulcer
Sterile ulcer (collagen vascular disease)
Staphylococcal hypersensitivity

Posterior segment involvement
Retinochoroidal fungal endophthalmitis
Retinochoroidal infection (eg, toxoplasmosis, toxocariasis)
Noninfectious posterior uveitis (eg, sarcoidosis, pars planitis)
Neoplastic conditions

WORKUP

Section 5 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Lab Studies

• CBC with cell differentials
• Blood agar
• Sabouraud dextrose agar without cycloheximide
• Thioglycolate broth
• Chocolate agar
• Löwenstein-Jensen medium
• Nonnutrient agar with E coli overlay
• Slides
• • Gram stain
  • Giemsa stain

Imaging Studies

• CT scan of the orbit and head may be helpful in case of trauma to look for foreign body.

Procedures

• Corneal ulcer: Anesthetize the cornea with topical drops, and, at the slit lamp, scrape the base and the leading edge of the infiltrate with the Kimura spatula, and place on the culture medium or slide.
• Endophthalmitis: Diagnostic and therapeutic vitrectomy to confirm the diagnosis and to evaluate the organisms' sensitivity to antibacterial agents.

Histologic Findings

E coli is a gram-negative rod. E coli has a fermentative and respiratory type of metabolism.

TREATMENT

Section 6 of 11  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical Care

• Ocular treatment
• • Cycloplegic (scopolamine 0.25%)
  • Antibiotics
  • • E coli conjunctivitis: Topical ciprofloxacin, ofloxacin, gatifloxacin, levofloxacin, moxifloxacin, or 0.3% tobramycin ophthalmic solutions are applied approximately 6-8 times daily until the infection appears to be resolved.
    • Smaller and peripheral corneal infiltrate: Intensive topical therapy infiltrate/ulcers; topical ciprofloxacin, ofloxacin, gatifloxacin, levofloxacin, moxifloxacin, or 0.3% tobramycin ophthalmic solutions are applied every hour while awake until the infection appears to be resolved. Reassess on a daily basis.
    • Large and central infiltrate: Fortified tobramycin, gentamicin (15 mg/mL), or fluoroquinolone (eg, ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin) 1 drop every 5 minutes for 5-7 doses, then repeat every other hour for 24 hours alternating with fortified cefazolin (50 mg/mL) or vancomycin (25 mg/mL) 1 drop every 5 minutes for 5-7 doses, then repeat every other hour for 24 hours; patient needs daily evaluation. Consider subconjunctival antibiotics of gentamicin or tobramycin (20-40 mg).
    • Endophthalmitis: Intravitreal injection of gentamicin or tobramycin 100-300 µg can be used. Amikacin can also be used at 400 µg. Intravitreal injection consists of total 0.1 mL. Intravitreal steroids are controversial. For eyes with corneal thinning, place a corneal shield without a patch. Contact lenses should not be worn. Oral pain and nausea medication may be given. Oral fluoroquinolone (ciprofloxacin 500 mg PO bid) should be considered because it penetrates the posterior segment well. Topical steroids in combination with antibiotics may reduce the massive inflammatory response of the eye, which is often as destructive as the infection.
• Systemic treatment
• • The choice of an appropriate antimicrobial agent in E coli infections depends on the site, type, and severity of infection. A number of antibiotics are effective against E coli, but no particular drug is uniformly active against all strains of E coli; therefore, sensitivity testing should guide the choice of antibiotics. Antimicrobial resistance occurs through plasmid-mediated determinants, several of which can be found in the same plasmid. These multiresistant plasmids can be transferred by conjugation.
  • For less severe E coli infections, the initial treatment of choice may be ampicillin (2-4 g/d IV or IM). Other penicillins with b-lactamase inhibitor, cephalosporins, nitrofurantoin, and trimethoprim/sulfamethoxazole may also be considered.
• • For more severe infections, ampicillin/sulbactam could be given (3 g IV q6h). Imipenem/cilastatin, ciprofloxacin IV, or cefotaxime may also be considered.
  • Kanamycin is generally indicated for the initial treatment of serious E coli infections. Severe urinary tract infections that seem to be resistant to other antimicrobial agents have responded to daily doses of kanamycin (15 mg/kg IM in divided doses q6-8h).
  • Alternative treatment may be a total daily dose of parenteral gentamicin (3-5 mg/kg in divided doses q8h). In severe infections that appear to be resistant to kanamycin and gentamicin, amikacin is indicated. Amikacin is given daily (15 mg/kg in 2-3 equally divided doses).
  • In severe cases of sepsis, a combination of antibiotics is given, which includes ampicillin and an aminoglycoside; the choice of which is based on knowledge of local susceptibility patterns. Ampicillin/sulbactam or cefotaxime (a potent third-generation cephalosporin) is a suitable alternative, especially if an aminoglycoside-resistant nosocomial organism is suspected.
  • Neomycin appears to be most effective against E coli gastroenteritis. An oral daily dose of 25 mg/kg is usually indicated for 1-2 days.

Surgical Care

• Possible penetrating corneal transplant for corneal perforation
• Posterior vitrectomy to reduce infective load and provide sufficient material for diagnostic culture and pathology

Consultations

• Anterior segment surgeons
• Retinal specialist

Diet

• Normal diet
• If surgery indicated, convert to nothing by mouth (NPO)

Activity

• Bed rest
• Admit to the hospital for monitor if necessary
• • Sight-threatening infection
  • Patient not able to administer medication
  • Risk of noncompliance
  • Patient not able to return daily

MEDICATION

Section 7 of 11  

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• Follow-up
• Miscellaneous
• Multimedia
• References

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

Drug Category: Antibiotics (fluoroquinolone)

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Drug Name	Ofloxacin (Ocuflox)
Description	Pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. Inhibits bacterial growth by inhibiting DNA gyrase. Indicated for superficial ocular infections of the conjunctiva or cornea caused by strains of microorganisms susceptible to ofloxacin.
Adult Dose	1 gtt q5min for 5-7 doses, then repeat q2h
Pediatric Dose	<1 year: Not recommended >1 year: Administer as in adults
Contraindications	Documented hypersensitivity
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Failure to respond after treating for 2-3 d may indicate presence of resistant organism or another causative agent

Drug Name	Tobramycin (Tobrex, AKTob)
Description	Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane. Available as a solution, ointment, and lotion.
Adult Dose	1 gtt q5min for 5-7 doses, then repeat q2h
Pediatric Dose	<2 years: Not established >2 years: Administer as in adults
Contraindications	Documented hypersensitivity; mycobacterial, viral, and fungal infections of the eye; steroid combinations after uncomplicated removal of a foreign body from cornea also should avoid using this product
Interactions	Anesthetics potentiate effects; effects decrease when used concurrently with gentamicin
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Do not use in deep-seated ocular infections or in those that may become systemic; prolonged use of antibiotics, may result in bacterial or fungal overgrowth of nonsusceptible organisms

Drug Name	Gentamicin (Ocumycin, Genoptic)
Description	Aminoglycoside antibiotic used for gram-negative bacterial coverage.
Adult Dose	1 gtt q5min for 5-7 doses, then repeat q2h 100 mcg/0.1 cc for intravitreal injection, 20 mg/0.5 cc for subconjunctival injection
Pediatric Dose	<2 years: Not established >2 years: Administer as in adults
Contraindications	Documented hypersensitivity; mycobacterial, viral, and fungal infections of the eye; steroid combinations after uncomplicated removal of a foreign body from cornea also should avoid using this product
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Do not use to treat ocular infections that may become systemic; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms and may lead to a secondary infections

Drug Name	Cefazolin (Kefzol, Zolicef)
Description	First-generation cephalosporin antibiotic for gram-positive bacterial coverage. Commonly used in combination with an aminoglycoside to achieve broad spectrum. This 50-133 mg/mL solution must be compounded.
Adult Dose	1 gtt q5min for 5-7 doses, then repeat q2h
Pediatric Dose	Administer as in adults
Contraindications	Documented hypersensitivity; viral, mycobacterial, and fungal infections of the eye; use of steroid combinations after uncomplicated removal of corneal foreign body
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Not for use in ocular infections likely to become systemic; bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

Drug Name	Vancomycin (Lyphocin, Vancoled, Vancocin)
Description	Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive, or have failed to respond to penicillins and cephalosporins or have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment. Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.
Adult Dose	500 mg to 2 g/d IV divided tid/qid 7-10 d 1 mg/0.1 cc for intravitreal injection 25 mg/0.5 cc for subconjunctival injection, or 25 mg/mL 1 gtt q5min for 1-7 doses depending on severity, repeat q1h
Pediatric Dose	Administer as in adults
Contraindications	Documented hypersensitivity
Interactions	Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced, when coadministered with nondepolarizing muscle relaxants
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Caution in renal failure, neutropenia; Red Man syndrome is caused by too rapid IV infusion (dose given over a few minutes) but rarely happens when dose given as 2-h administration or as PO or IP administration; Red Man syndrome is not an allergic reaction

Drug Name	Gatifloxacin (Zymar)
Description	Fourth-generation fluoroquinolone ophthalmic indicated for bacterial conjunctivitis. Elicits a dual mechanism of action by possessing an 8-methoxy group, thereby inhibiting the enzymes DNA gyrase and topoisomerase IV. DNA gyrase is involved in bacterial DNA replication, transcription, and repair. Topoisomerase IV is essential in chromosomal DNA partitioning during bacterial cell division.
Adult Dose	Days 1-2: Instill 1 gtt into affected eye(s) q2h while awake; not to exceed 8 administrations/d Days 3-7: Instill 1 gtt into affected eye(s) up to 4 times/d while awake
Pediatric Dose	<1 year: Not established >1 year: Administer as in adults
Contraindications	Documented hypersensitivity
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	For ophthalmic use only; commonly causes conjunctival irritation, increased lacrimation, corneal inflammation, or papillary conjunctivitis; less common adverse effects include conjunctival hemorrhage, dry eye, eye discharge, eye irritation, eye pain, eyelid swelling, headache, red eye, reduced visual acuity, or taste disturbance

Drug Name	Levofloxacin (Quixin)
Description	S-enantiomer of ofloxacin. Inhibits DNA gyrase in susceptible organisms, thereby inhibiting relaxation of supercoiled DNA and promoting breakage of DNA strands.
Adult Dose	Instill 1-2 gtt in affected eye(s) qid for 1 wk
Pediatric Dose	Administer as in adults
Contraindications	Documented hypersensitivity
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Failure to respond after treating for 2-3 d may indicate presence of resistant organism or another causative agent; do not use in ocular infections that may become systemic; superinfections may occur with prolonged or repeated antibiotic therapy

Drug Name	Moxifloxacin (Vigamox)
Description	Indicated to treat bacterial conjunctivitis. Elicits antimicrobial effects. Inhibits topoisomerase II (DNA gyrase) and IV enzymes. DNA gyrase is essential in bacterial DNA replication, transcription, and repair. Topoisomerase IV plays a key role in chromosomal DNA portioning during bacterial cell division.
Adult Dose	Instill 1 gtt in affected eye(s) tid for 7 d
Pediatric Dose	<1 year: Not established >1 year: Administer as in adults
Contraindications	Documented hypersensitivity
Interactions	None reported
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Prolonged use may cause organism overgrowth and result in superinfection; do not wear contact lenses until infection clears and eye drops discontinued

Drug Category: Cycloplegics

Instillation of a long-acting cycloplegic agent can relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.

Drug Category: Corticosteroids

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

FOLLOW-UP

Section 8 of 11  

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• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Further Outpatient Care

• Daily evaluation initially to include the following:
• • Repeated measurement of visual acuity, the size of the infiltrate, ulcer, and epithelial defect
  • Anterior chamber reaction
  • Intraocular pressure
  • Level of hypopyon
  • Fundus examination
• In an impending or completed corneal perforation, consider a corneal transplant or patch graft.
• Cyanoacrylate tissue glue also may work in a treated corneal ulcer.

In/Out Patient Meds

• Topical antibiotics
• Cycloplegics
• Topical steroids
• Periocular antibiotics
• Oral/intravenous antibiotics if needed
• Antiemetics
• Analgesics

Deterrence/Prevention

• Early detection and aggressive treatment

Complications

• Cataract formation
• Corneal perforation
• Glaucoma
• Hyphema
• Loss of vision
• Retinal detachment
• Possible need for enucleation
• Meningitis

Prognosis

• Because of the aggressive nature of the disease, prognosis is poor unless aggressive and early treatment is initiated.

MISCELLANEOUS

Section 9 of 11  

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• Workup
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• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Medical/Legal Pitfalls

• Delayed initiation of treatment

MULTIMEDIA

Section 10 of 11  

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• Workup
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• Medication
• Follow-up
• Miscellaneous
• Multimedia
• References

Media file 1:  Bacterial corneal ulcer with hypopyon.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 11 of 11

• Authors and Editors
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• Differentials
• Workup
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• Follow-up
• Miscellaneous
• Multimedia
• References

• Aronson SB, Elliott JH. Ocular Inflammation. St Louis: CV Mosby;. 1972: 103-5, 112-4.
• Balestrazzi A, Blasi MA, Primitivo S, Balestrazzi E. Escherichia coli endophthalmitis after trans-scleral resection of uveal melanoma. Eur J Ophthalmol. Sep-Oct 2002;12(5):437-9. [Medline].
• Bonadio WA, Smith DS, Madagame E, et al. Escherichia coli bacteremia in children. A review of 91 cases in 10 years. Am J Dis Child. Jun 1991;145(6):671-4. [Medline].
• Charoo NA, Kohli K, Ali A, Anwer A. Ophthalmic delivery of ciprofloxacin hydrochloride from different polymer formulations: in vitro and in vivo studies. Drug Dev Ind Pharm. Feb 2003;29(2):215-21. [Medline].
• Cordido M, Fernandez-Vigo J, Cordido F, Rey AD. Bilateral metastatic endophthalmitis in diabetics. Acta Ophthalmol (Copenh). Apr 1991;69(2):266-7. [Medline].
• Eisenstein BI. Escherichia coli infections. In: Harrison's Principles of Internal Medicine. 1994: 661-3.
• Epstein SP, Bottone EJ, Asbell PA. Susceptibility testing of clinical isolates of pseudomonas aeruginosa to levofloxacin, moxifloxacin, and gatifloxacin as a guide to treating pseudomonas ocular infections. Eye Contact Lens. Sep 2006;32(5):240-4. [Medline].
• Fanning WL, Stubbert J, Irwin ES, Aronson MD. A case of bilateral Escherichia coli endogenous endophthalmitis. Am J Med. Aug 1976;61(2):295-7. [Medline].
• Faraawi R, Fong IW. Escherichia coli emphysematous endophthalmitis and pyelonephritis. Case report and review of the literature. Am J Med. Mar 1988;84(3 Pt 2):636-9. [Medline].
• Glasser DB, Baum J. Antibacterial agents. In: Infections of the Eye. 1996: 207-30.
• Hyndiuk RA, Cokington CD. Bacterial keratitis. In: Infections of the Eye. 1996: 323-47.
• Katz HR. A retrospective study of endophthalmitis rates comparing quinolone antibiotics. Am J Ophthalmol. Oct 2005;140(4):771-2; author reply 772-3. [Medline].
• Munoz Morente A, Baron Ramos MA, Mateos Fernandez S, Reguera Iglesias JM. Endogenous bacterial endophthalmitis: a case report and brief review [in Spanish]. An Med Interna. Dec 2004;21(12):597-8. [Medline].
• Park SB, Searl SS, Aquavella JV, Erdey RA. Endogenous endophthalmitis caused by Escherichia coli. Ann Ophthalmol. Mar 1993;25(3):95-9. [Medline].
• Sanford JP, Gilbert DN, Sande MA. Antimicrobial. In: Guide to Antimicrobial Therapy. 1997:47.
• Sekimoto M, Hayasaka S, Setogawa T, Shigeno K. Endogenous Escherichia coli endophthalmitis in a patient with autosomal-dominant polycystic kidney disease. Ann Ophthalmol. Dec 1991;23(12):458-9. [Medline].
• Shammas HF. Endogenous E. coli endophthalmitis. Surv Ophthalmol. Mar-Apr 1977;21(5):429-35. [Medline].
• Starr MB. A retrospective study of endophthalmitis rates comparing quinolone antibiotics. Am J Ophthalmol. Oct 2005;140(4):769-70; author reply 770-1. [Medline].
• Sunakawa K, Nonoyama M, Ooishi T, et al. The trend of childhood bacterial meningitis in Japan (2000-2002) [in Japanese]. Kansenshogaku Zasshi. Oct 2004;78(10):879-90. [Medline].
• Tseng CY, Liu PY, Shi ZY, et al. Endogenous endophthalmitis due to Escherichia coli: case report and review. Clin Infect Dis. Jun 1996;22(6):1107-8. [Medline].
• Turck M, Schaberg D. Infections due to enterobacteriaceae. In: Harrison's Principles of Internal Medicine. 1980: 629-34.
• Walmsley RS, David DB, Allan RN, Kirkby GR. Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic. Postgrad Med J. Jun 1996;72(848):361-3. [Medline].
• Wann SR, Liu YC, Yen MY, et al. Endogenous Escherichia coli endophthalmitis. J Formos Med Assoc. Jan 1996;95(1):56-60. [Medline].
• Zhang YQ, Wang WJ. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina. Sep 2005;25(6):746-50. [Medline].

Article Last Updated: Jan 10, 2007