Cluster outbreak of Pseudomonas stutzeri acute endophthalmitis following phacoemulsification: A report of 14 cases from North India

Purpose: To report clinical features, antibiotic susceptibility profile, management, and outcomes of a cluster outbreak of post?cataract surgery Pseudomonas stutzeri endophthalmitis. Methods: This was a hospital?based case series in which 14 patients with acute postoperative endophthalmitis who underwent cataract surgery on the same day were included. Based on severity of presentation, they either underwent pars plana vitrectomy (PPV) with intraocular antibiotics (IOAB) or vitreous tap with IOAB. Vitreous aspirates and environmental surveillance samples were inoculated on culture media and further processed by MALDI?TOF MS for identification and Vitek3 for susceptibility profile. Results: There were 8 females and 6 males with a mean age of 62.14 ± 8.08 years. Presenting signs included corneal folds (100%), hypopyon (57.1%) and fibrin (50%). Ten patients with mild presentation underwent vitreous tap with IOAB. Four patients with severe presentation underwent PPV with IOAB. Pseudomonas stutzeri was isolated from the vitreous samples and was pan?sensitive. Six eyes required multiple interventions. Favorable outcome was obtained in 12 eyes, one eye developed phthisis, and one patient was lost to follow?up. Conclusion: We report the first ever cluster outbreak of Pseudomonas stutzeri endophthalmitis following phacoemulsification with IOL implantation in a single surgeon setting. Majority of the patients had a mild presentation and responded well to targeted anti?microbial treatment.

Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.

Postoperative endophthalmitis due to Pseudomonas luteola: First reported case of acute and virulent presentation from a tertiary eye care center in South India

A 60-year-old male presented with pain and decreased vision 3 weeks following uneventful intracapsular cataract extraction with anterior vitrectomy for subluxated cataract. A diagnosis of acute endophthalmitis was made based on clinical and ultrasound features. Patient improved only after undergoing pars plana vitrectomies twice and repeated intravitreal antibiotic-steroid injections. Vitreous aspirate revealed Gram-negative bacillus identified as Pseudomonas luteola on culture. Patient returned with a retinal detachment at first follow-up which was treated with vitrectomy, endolaser, and silicone oil tamponade. To the best of our knowledge, this is the first case of P. luteola causing acute onset, virulent endophthalmitis reported in literature.

Factores de riesgo de la endoftalmitis aguda poscirugía de catarata / Risk factors for acute endophthalmitis after cataract surgery

Se realizó una revisión de los factores de riesgo de la endoftalmitis aguda poscirugía de catarata. Se actualizan aspectos como la fuente de infección y el mecanismo de producción, factores predisponentes para que la contaminación de la cámara anterior se convierta en una infección intraocular, patogenicidad y virulencia del germen, resistencia bacteriana y susceptibilidad del huésped. Se concluye que aunque son múltiples los factores de riesgo asociados a la aparición de una endoftalmitis aguda posquirúrgica, la entrada de gérmenes al interior del ojo a través de la incisión quirúrgica (contaminación) durante el trans o posoperatorio es una condición necesaria pero no determinante para la aparición de la infección. El tamaño del inóculo, unido a la virulencia del germen, la resistencia bacteriana y la susceptibilidad individual del paciente, podrían determinar el desarrollo de una endoftalmitis posquirúrgica(AU)

A bibliographic review of the main risk factors for developing an acute endophthalmitis after cataract surgery was achieved. Aspects such as the infection source and mechanism of production, predisposing factors to develop an intraocular infection from a contaminated anterior chamber, pathogenicity and virulence of the infectious agent, bacterial resistance and host susceptibility were updated. It is concluded that although several risk factors are associated with the appearance of an acute post-surgical endophthalmitis, the entry of germs inside the eye through the surgical incision during the trans or post-operative moment is a necessary but not determinant condition for the onset of infection. The size of the inoculum linked to the virulence of the germ, bacterial resistance and individual susceptibility of the patient could determine the development of an acute endophthalmitis after cataract surgery(AU)

Vitrectomy versus Intravitreal Antibiotic Injection to Treat Acute Endophthalmitis Developing after Cataract Surgery

PURPOSE: To compare the therapeutic efficacy of vitrectomy plus intravitreal antibiotic injection (vitrectomy group) with intravitreal antibiotic injection alone (antibiotic group) for eyes with acute endophthalmitis developed after cataract surgery with visual acuity of hand motion or better. METHODS: In this retrospective chart review, we compared the visual acuities of 10 eyes of a vitrectomy group and 17 eyes of an antibiotic group. RESULTS: We found no significant differences between the two groups in terms of age, comorbidities (diabetes, hypertension), time of symptom onset, time of diagnosis, type of systemic antibiotic prescribed, or positive culture rate. Mean baseline best-corrected visual acuity (BCVA) was similar in the two groups (2.17 vs. 1.96 logMAR; p = 0.60). Both groups exhibited significant improvements in mean BCVA after 2 months: from 2.17 to 0.81 logMAR in the vitrectomy group (p = 0.01) and from 1.96 to 0.76 logMAR in the antibiotic group (p = 0.002), but the final BCVA did not differ significantly between the two groups (0.81 vs. 0.76 logMAR, p = 0.75). CONCLUSIONS: Both vitrectomy combined with intravitreal antibiotic injection and intravitreal antibiotic injection alone significantly improved visual acuity; the final BCVA did not differ between the two groups. Intravitreal antibiotic injection alone may be an effective first-line treatment for endophthalmitis in patients with initial visual acuity of hand motion or better.

Factors Associated with a Poor Visual Result in Acute Endophthalmitis After Cataract Surgery

PURPOSE: To determine the factors related to the clinical outcome of acute endophthalmitis after cataract surgery. METHODS: Authors performed a retrospective study of 65 eyes of 65 patients who had been treated for endophthalmitis from 2001 to 2006 at our hospital. We analyzed the relationship between final visual outcomes and prognostic factors. RESULTS: Final visual acuities were 0.5 or better in 49.2% of all eyes. Of 57 eyes, 29 eyes (50.8%) were culture positive. Staphylococcus epidermidis and Streptococcus pneumoniae were the most common organisms isolated. Cases with baseline acuity of counting fingers or better, cases with culture-negative or gram-positive infection, and cases not requiring vitrectomy had better prognoses. CONCLUSIONS: Baseline visual acuity, type of cultured organism, and method of treatment are significantly related to visual prognosis.