Pseudomonas aeruginosa endophthalmitis in a preterm infant

Gram-Negative Endogenous Endophthalmitis: A Systematic Review

Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.

Pediatric infectious endophthalmitis: a review

Infectious endophthalmitis is a rare but severe complication of septecemia, intraocular surgeries, or penetrating eye trauma. The etiology, prognosis, and management of pediatric endophthalmitis resulting from exogenous and endogenous infections are reviewed. Open-globe trauma and glaucoma surgery are the most frequent causes of endophthalmitis in children, whereas endogenous infection is the least common cause. Streptococcus and Staphylococcus species are common bacterial agents in both posttraumatic and postoperative pediatric endophthalmitis, whereas Candida albicans is a commonly reported organism in endogenous endophthalmitis. Additionally, Streptococcus pneumoniae and Haemophilus influenzae appear more likely as pathogens in children than in adults. The clinical manifestations and outcome usually correlate with the virulence of the infecting organism. The visual prognosis of endophthalmitis is generally poor.

[Pseudomonas aeruginosa unilateral endogenous endophthalmitis in a preterm infant: a case report]

Endogenous endophthalmitis is a rare eye disease, affecting vulnerable subjects (such as preterm or older elderly subjects), with reserved visual and sometimes vital prognosis. We present a preterm boy, born at 35 weeks and 2 days gestation, who developed a right eye Pseudomonas aeruginosa endogenous endophthalmitis secondary to a left-foot peripherical catheter-infection-associated bacteremia. He had a first intravenous antibiotic therapy associating third-generation cephalosporin and fluoroquinolone, then Ceftazidime® by intravitreous injection and a subconjunctival injection of betamethasone. Because of the development of vitreoretinal retraction, phacophagia and vitrectomy were performed. We point and discuss the severity of this disease, associated with poor visual and vital prognosis, and the importance of prompt biological diagnosis so that the appropriate intravenous antibiotic therapy is chosen. Treatment is also discussed, especially the interest value of antibiotic intravitreous injection in preterm infants.

Acute Phthisis Bulbi in a Premature Infant

A neonate with an estimated gestational age of 32 weeks who had post-partum sepsis (methicillin-resistant Staphylococcus aureus [MRSA] and Pseudomonas aeruginosa) and MRSA meningitis was found to have blunted light reflexes and microphthalmia in both eyes on routine screening for retinopathy of prematurity. Retrolenticular membranes precluded visualization of the fundi. Computed tomography confirmed the presence of intraocular calcifications, an interval development over 6 weeks from previously normal scans. Referral was made and diagnostic enucleation of the right eye was performed, revealing intraocular disorganization and metaplasia consistent with phthisis following intraocular inflammation. The patient's contralateral eye achieved visual acuity of light perception after lensectomy and vitrectomy. Vitreous cultures from the enucleation specimen and from the fellow eye at the time of vitrectomy were negative. Unsuspected, untreated endogenous endophthalmitis can result in dramatic and rapid metaplastic response in the developing eye and result in acute phthisis.

Endogenous endophthalmitis caused by Pseudomonas aeruginosa in a preterm infant: a case report

Endophthalmitis is an infection of the vitreous or aqueous humor of the eye. Although it rarely occurs in the neonatal period it has been previously diagnosed in preterm infants.Endogenous endophthalmitis is when eye infection is secondary to septicemia and represent 20% of the cases of endophthalmitis. Pseudomonas aeruginosa is responsible for more than 75% of invasive neonatal eye infections. The course of pseudomonal endophthalmitis is typically fulminant, developing over hours even in early diagnosis. For survivors, the usual result is blindness of the affected eye.We report the case of a preterm infant who developed septicemia and was later diagnosed as having a pseudomonas endophthalmitis.

Role of neutrophils, MyD88-mediated neutrophil recruitment, and complement in antibody-mediated defense against Pseudomonas aeruginosa keratitis

Purpose. Ulcerative keratitis due to Pseudomonas aeruginosa is a sight-threatening disease leading to loss of vision due to corneal inflammation. A human IgG1 monoclonal antibody (MAb F429) to the alginate capsule significantly reduces pathology and bacterial burdens in the cornea when applied topically starting 8 hours post-infection. The purpose of this study was to determine whether local polymorphonuclear neutrophils (PMN) recruitment and complement were important lipopolysaccharide co-factors in MAb F429-mediated reductions in P. aeruginosa tissue levels and corneal pathology. Methods. MyD88 knock-out mice unable to recruit PMN to tissues, mice depleted of PMNs, or mice depleted of complement component C3 were topically treated with MAb F429 starting 8 hours post-infection and evaluated for bacterial levels and corneal pathology 48 hours after infection with two P. aeruginosa isolates. Results. An inability to recruit PMN or systemic PMN depletion plus topical application of MAb F429 resulted in less pathology in the eye, but bacterial burdens were markedly increased in the cornea, brains, and spleens of these mice, indicative of systemic spread. Intraperitoneal injection of cobra venom factor (CVF) reduced C3 levels in the cornea approximately 40%, which did not change the beneficial effects of MAb F429. Both systemic injection and topical application of CVF reduced local C3 levels >60%, which eliminated MAb-mediated reductions in corneal pathology and bacterial levels. Conclusions. PMN recruitment and complement are both needed for maximal in vivo efficacy of MAb F429 in therapeutically treating P. aeruginosa keratitis, and attempts to reduce pathology by limiting PMN influx could have consequences leading to more extensive local and systemic infection.

Bilateral endogenous endophthalmitis due to pseudomonas aeruginosa in a neonate

BACKGROUND

Bacterial eye infections are rare in the neonatal population and usually come from exogenous spread. Eye infection due to Pseudomonas aeruginosa, although uncommon, may be a devastating disease, especially in premature infants.

METHODS

Retrospective review of the clinical chart of a 10-day-old newborn baby with bilateral endogenous Pseudomonas aeruginosa endophthalmitis.

RESULTS

The patient presented with leukokoria in both eyes 7 days after the onset of severe septicemia due to endophthalmitis in both eyes. The baby received systemic treatment with meropenem and vancomycin, which the cultured bacteria were susceptible to, but the infection progressed. Intravitreal ceftazidime treatment and later vitrectomy could not prevent complete retina detachment and the progressive evolution to phthisis.

CONCLUSION

Aggressive therapy including systemic antibiotics, intravitreous antibiotic injection, and vitrectomy could not prevent a poor outcome leading to retinal detachment and blindness in both eyes. A discussion of the treatment options and a review of the literature are also included.