Prognostic utility of whole genome sequencing and polymerase chain reaction tests of ocular fluids in post-procedural endophthalmitis.

Abstract Purpose To associate detection of potential pathogen DNA in endophthalmitis with clinical outcomes Design Prospective cohort study Methods Patients diagnosed with endophthalmitis following an intraocular procedure were recruited. Clinical outcome data from baseline, week 1, month 1 and month 3 visits were collected. Intraocular biopsy samples were cultured by standard methods. Quantitative polymerase chain reaction (qPCR) for specific pathogens and whole genome sequencing (WGS) were performed. Results A total of 50 patients (mean age 72, 52% male) were enrolled. Twenty-four cases were culture-positive and 26 were culture-negative. WGS identified the cultured organism in 76% of culture-positive cases and identified potential pathogens in 33% of culture-negative cases. Month 1 and 3 visual acuities did not vary by pathogen-positive vs pathogen-negative cases as detected by either culture or WGS. Visual outcomes of S. epidermidis endophthalmitis were no different than those of pathogen-negative cases, while the patients infected with other pathogens showed worse outcome. Higher baseline bacterial DNA loads of bacteria other than S.epidermidis detected by WGS were associated with worse month 1 and 3 visual acuity, while the S.epidermidis loads did not appear to influence outcomes. Torque teno virus (TTV) and Merkel cell polyomavirus (MCV) were detected by qPCR in 49% and 19% of cases, respectively. Presence of TTV at presentation was associated with a higher rate of secondary PPV (p=0.009) and retinal detachment (p=0.022). Conclusion Presence and higher load of bacteria other than S. epidermidis detected by WGS or DNA from TTV by qPCR in ocular fluids is associated with worse outcomes in post-procedure endophthalmitis.