Areas of uncertainty in endophthalmitis care

Table 3 Geographic variability in endophthalmitis: Microbiology, resistance patterns, and clinical implications

Region/setting	Ref.	Dominant microbial pattern	Key resistance/risk signal	Practical clinical implication
North America/Western Europe	Flynn et al[52], 2008	Coagulase-negative Staphylococcus, Staphylococcus aureus	Rising fluoroquinolone resistance; preserved susceptibility to intravitreal first-line agents	Standard empirical regimens generally effective, but ongoing surveillance required
South Asia	Topol et al[112], 2019	Higher burden of Gram-negative organisms (Pseudomonas, Klebsiella) and fungi	Increasing resistance to fluoroquinolones and cephalosporins	Broader empirical coverage; early consideration of fungal infection
East Asia	Wong et al[113], 2000	Mixed Gram-positive/Gram-negative spectrum; higher streptococcal prevalence	Marked regional variability; limited standardized resistance data	Local microbiological data essential for empirical decision-making
Middle East	Shams Abadi et al[114], 2023; Falavarjani et al[115], 2012	Predominantly Gram-positive; Gram-negative organisms in trauma	Emerging multidrug-resistant Gram-negative isolates	Trauma-associated cases may warrant early surgery and tailored therapy
Africa	Solomon et al[116], 2025	Higher proportion of post-traumatic and endogenous infections	Sparse resistance data; limited laboratory infrastructure	Empirical management common; need for regional registries and surveillance
Latin America	Morris et al[53], 2021	Heterogeneous spectrum (Gram-positive, Gram-negative, fungal)	Increasing resistance reported in tertiary centers	Empirical therapy often requires regional customization
Post-traumatic Endophthalmitis (Global)	Mitra et al[117], 2021; Long et al[118], 2014	Bacillus spp., Gram-negative organisms	High virulence predominates over resistance	Early vitrectomy and aggressive therapy prioritized
Endogenous Endophthalmitis (Global)	Kuhn et al[54], 2006	Candida, Aspergillus, Gram-negative bacteraemia-associated organisms	Resistance influenced by prior systemic antimicrobial exposure	Requires systemic source control and prolonged, coordinated therapy

Bacillus spp.: Bacillus species.