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Velcani F, Kuo IC, Shanks RMQ, Chodosh J, Garg P, Amescua G, Zegans ME. Association of Artificial Tears with Ocular and Systemic Infection: Carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) Outbreak. Ophthalmology 2023; 130:1118-1120. [PMID: 37452816 PMCID: PMC11182435 DOI: 10.1016/j.ophtha.2023.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
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2
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Ramamurthy SR, Joseph J, Dave VP. Clinical settings, management and factors affecting outcomes in multi and extensively-drug resistant Pseudomonas endophthalmitis. Eur J Ophthalmol 2023; 33:1997-2005. [PMID: 36908204 DOI: 10.1177/11206721231163353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To report the clinical settings, management and factors affecting outcomes in multi-drug resistant (MDR) and extensively-drug resistant (XDR) Pseudomonas endophthalmitis. SETTINGS Retrospective, consecutive, non-comparative interventional case series. Cases of MDR and XDR Pseudomonas endophthalmitis from January 2012 to December 2020 treated at our tertiary eye care center were included. Data collected included clinical data, anatomic and functional outcome, isolated micro-organisms, and culture sensitivity. RESULTS This study included 29 eyes of 29 patients with MDR/XDR Pseudomonas endophthalmitis. Mean age at presentation was 60.27 ± 14.9 years (median 63). Commonest clinical setting was acute post-operative endophthalmitis in 27 cases (93.1%). Concurrent corneal infiltrate was present in 11 eyes (37.9%). Initial intervention in 19 eyes (65.5%) was vitrectomy, 2 of which underwent endoscopic pars plana vitrectomy. Mean number of interventions was 3.34 ± 1.44 (median 4). Mean follow up was 3.25 ± 3.07 months (median 2). Sensitivity to ceftazidime was 48.28%. All isolates were sensitive to colistin. Mean visual acuity at last follow up in logMAR was 2.64 ± 1.48 (median 3.5). Seven eyes (24.13%) were NPL (nil perception of light) at the last follow up. Two eyes (6.9%) underwent evisceration. Nine eyes (31.03%) had a favourable anatomic and functional outcome. Eyes without a corneal infiltrate at presentation were found to have a favourable anatomic and favourable functional outcome (OR 11.91, P < 0.04, CI 1.08 to 130.93). CONCLUSION Corneal involvement at presentation is associated with poorer outcomes in MDR and XDR Pseudomonas endophthalmitis. There is a potential role of higher newer antibiotics especially colistin in the management of these cases.
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Affiliation(s)
- Srishti Raksheeth Ramamurthy
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
- Standard Chartered Academy for Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
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3
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Dowler KK, Vientós-Plotts A, Giuliano EA, McAdams ZL, Dorfmeyer RA, Reinero CR, Ericsson AC. Ophthalmic viscoelastics commonly used in cataract surgery: A microbiota investigation. Vet Ophthalmol 2023. [PMID: 36772992 DOI: 10.1111/vop.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To survey commonly used, sterile ophthalmic viscoelastic materials used during routine cataract surgery for the presence of bacterial DNA and/or viable bacteria and endotoxin quantification. METHODS Samples from three different ophthalmic viscoelastic manufacturers and three different production lots per manufacturer were collected for 16 S ribosomal ribonucleic acid (rRNA) sequencing and conventional aerobic and capnophilic bacterial culture. Other samples of viscoelastic material from the same three manufacturers were collected for endotoxin quantification using a commercially available Limulus amebocyte lysate (LAL) assay. Statistical analysis was performed using Sigma Plot 14.0, and R v4.0.2.0. Differences (p ≤ .05) between sample collection sites in total DNA concentration, microbial richness, mean intra-group distances, and endotoxin quantification alongside reagent controls were evaluated. RESULTS Culture yielded two isolates, identified as Staphylococcus epidermidis and Bacillus megaterium. 16 S rRNA sequencing revealed no differences between brands in richness or overall composition. The most common bacterial DNA detected across all brands was Staphylococcus sp., Cutibacterium sp., Flavobacterium sp., and Lactobacillus sp. A significant difference was found between the median endotoxin concentration between Anvision and Hyvisc® viscoelastic (Anvision: 0.171 EU/mL, Hyvisc®: 0.03 EU/mL; p < .001). CONCLUSIONS No brand-specific differences in bacterial DNA were detected in the viscoelastic materials. Staphylococcus, Cutibacterium, Flavobacterium, and Lactobacillus were the dominant contributors to the bacterial DNA detected. Although Anvision viscoelastic samples contained significantly more endotoxin than Hyvisc® viscoelastic samples, endotoxin concentrations were below the FDA limit of 0.2 EU/mL for both manufacturers. These data further the understanding of inflammatory outcomes following cataract surgery.
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Affiliation(s)
- Kourtney K Dowler
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Aida Vientós-Plotts
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Elizabeth A Giuliano
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Zachary L McAdams
- Molecular Pathogenesis and Therapeutics Program, University of Missouri, Columbia, Missouri, USA
| | - Rebecca A Dorfmeyer
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Carol R Reinero
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Aaron C Ericsson
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
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4
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Dowler KK, Vientós-Plotts A, Giuliano EA, McAdams ZL, Reinero CR, Ericsson AC. Molecular and microbiological evidence of bacterial contamination of intraocular lenses commonly used in canine cataract surgery. PLoS One 2022; 17:e0277753. [PMID: 36409704 PMCID: PMC9678303 DOI: 10.1371/journal.pone.0277753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
Inflammatory outcomes, including toxic anterior segment syndrome (TASS) and infectious endophthalmitis, are potentially painful, blinding complications following cataract surgery. In an in vitro pilot study, commercially available, sterile foldable intraocular lenses (IOLs) used during routine canine cataract surgery, and their packaging fluid were surveyed for the presence of bacterial DNA and/or viable (cultivable) bacteria. Swabs from IOLs and packaging fluid from three different veterinary manufacturers and three different production lots/manufacturer were collected for 16S ribosomal ribonucleic acid (rRNA) sequencing. Packaging fluid samples were collected for aerobic/capnophilic bacterial culture. Culture yielded one isolate, identified as Staphylococcus epidermidis. 16S rRNA sequencing revealed distinct brand-specific bacterial DNA profiles, conserved between IOLs and packaging fluid of all production lots within each manufacturer. The dominant taxonomy differentiating each manufacturer was annotated as Staphylococcus sp, and was a 100% match to S. epidermidis. Distinct mixtures of bacterial DNA are present and consistent in IOLs and packaging fluid depending on the manufacturer, and Staphylococcus is the dominant contributor to the bacterial DNA detected. Caralens products had a significantly lower amount of Staphylococcus spp. compared to Anvision and Dioptrix products.
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Affiliation(s)
- Kourtney K. Dowler
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States of America
| | - Aida Vientós-Plotts
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States of America
| | - Elizabeth A. Giuliano
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States of America
| | - Zachary L. McAdams
- Molecular Pathogenesis and Therapeutics Program, University of Missouri, Columbia, Missouri, United States of America
| | - Carol R. Reinero
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States of America
| | - Aaron C. Ericsson
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, United States of America
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5
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Coall SM, Groth AD, White J, Crowe YC, Billson FM, Premont JE. Prospective evaluation of the prevalence of conjunctival and intraocular bacteria in dogs undergoing phacoemulsification following a standardized aseptic preparation with 0.5% povidone iodine. Vet Ophthalmol 2022; 25:434-446. [PMID: 36083221 DOI: 10.1111/vop.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate bacterial contamination of conjunctiva and aqueous humor in dogs undergoing phacoemulsification following asepsis with 0.5% povidone iodine and determine the influence of intravenous antibiotics on outcome of contamination. METHODS Client-owned dogs were prospectively enrolled and randomly assigned to a control group, receiving 22 mg/kg intravenous cefazolin at induction prior to sampling, or experimental group receiving no antibiotic prior to sampling, masked to the surgeon. Dogs receiving antimicrobials in the pre-operative period were excluded. Asepsis was performed on all operated eyes using 0.5% iodine with minimum 3 min contact time at induction of anesthesia and repeated before surgery. A conjunctival swab and aqueous humor sample were collected prior to incision and following incision closure, respectively. Samples were submitted for aerobic and anaerobic bacterial culture and susceptibility. RESULTS Seventy-one eyes of 42 dogs were included. Median age was 9 years. Thirty-nine and 32/71 eyes received intravenous cefazolin and no antibiotic, respectively. Median procedure time was 40 min per eye. Conjunctival cultures were positive in 6 eyes (8.5%): Serratia marcescens (5 eyes) and Cutibacterium acnes (1 eye). Aqueous humor cultures were positive in 5 eyes (7.0%): S. marcescens (2 eyes), Pseudomonas aeruginosa (2 eyes), Staphylococcus pseudointermedius (1 eye). Prevalence of positive culture did not differ between groups (p = .74), order of eyes for bilateral procedures (p = .74) and diabetic status (p = 1). CONCLUSIONS Bacterial contamination of the conjunctiva and aqueous humor was present in 8.5% and 7.0% of dogs undergoing phacoemulsification after asepsis. Lack of IV cefazolin was not significantly associated with positive culture.
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Affiliation(s)
- Sarah M Coall
- Department of Ophthalmology, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Alyson D Groth
- Department of Ophthalmology, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Joanna White
- Department of Internal medicine, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Yvette C Crowe
- Department of Ophthalmology, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Francis M Billson
- Department of Ophthalmology, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Johana E Premont
- Department of Ophthalmology, Small Animal Specialist Hospital, Sydney, New South Wales, Australia
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6
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Chin M, Khan I. Postoperative Pseudomonas aeruginosa endophthalmitis associated with asymptomatic bacteriuria. BMJ Case Rep 2022; 15:e246985. [PMID: 35459647 PMCID: PMC9036181 DOI: 10.1136/bcr-2021-246985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
An 86-year-old man with diabetes and a history of prostate cancer, indwelling urinary catheter and Pseudomonas aeruginosa bacteriuria presented on day 4 post left phacoemulsification cataract extraction and intraocular lens implant with signs and symptoms of postoperative endophthalmitis. Vitreous sample was positive for P. aeruginosa Prompt treatment with intravitreal antibiotics was initiated followed by anterior chamber washout with pars plana vitrectomy; however, the visual outcome was poor.
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Affiliation(s)
- Melissa Chin
- Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Imran Khan
- Ophthalmology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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7
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Verma L, Agarwal A, Dave VP, Honavar SG, Majji AB, Lall A, Mahobia A, Grover AK, Gupta A, Shroff C, Talwar D, Ravindra MS, Goyal M, Sharma N, Kamdar PA, Bhende P, Samant P, Rishi P, Ravindran RD, Narayanan R, Sinha R, Pappuru RR, Kumar SS, Saravanan VR, Lahane TP, Gajiwala U, Pradeep V. All India Ophthalmological Society (AIOS) Task Force guidelines to prevent intraocular infections and cluster outbreaks after cataract surgery. Indian J Ophthalmol 2022; 70:362-368. [PMID: 35086198 PMCID: PMC9023903 DOI: 10.4103/ijo.ijo_94_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Infectious endophthalmitis is a serious and vision-threatening complication of commonly performed intraocular surgeries such as cataract surgery. The occurrence of endophthalmitis can result in severe damage to the uveal and other ocular tissues even among patients undergoing an uncomplicated surgical procedure. If the infections result from common factors such as surgical supplies, operative or operation theater-related risks, there can be a cluster outbreak of toxic anterior segment syndrome (TASS) or infectious endophthalmitis, leading to several patients having an undesirable outcome. Since prevention of intraocular infections is of paramount importance to ophthalmic surgeons, the All India Ophthalmological Society (AIOS) has taken the lead in the formation of a National Task Force to help ophthalmic surgeons apply certain universal precautions in their clinical practice. The Task Force has prepared a handy checklist and evidence-based guidelines to minimize the risk of infectious endophthalmitis following cataract surgery.
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Affiliation(s)
| | - Aniruddha Agarwal
- Department of Ophthalmology, Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | | | | | | | | | | | | | - M S Ravindra
- Karthik Netralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Mallika Goyal
- Department of Ophthalmology, Apollo Eye Hospital, Apollo Health City, Hyderabad, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pramod Bhende
- Director, Sri Bhagwan Mahavir Department of Vitreoretinal Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Preetam Samant
- P. D. Hinduja Hospital, Mahim, Mumbai, Maharashtra, India
| | - Pukhraj Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - R D Ravindran
- Department of Ophthalmology, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - V R Saravanan
- Department of Ophthalmology, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Tatyarao P Lahane
- Department of Ophthalmology, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Uday Gajiwala
- Divyajyoti trust, Mandvi, Dist. Surat, Gujarat, India
| | - Venkatesh Pradeep
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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8
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Arora R, Goel R, Loomba P, Khanam S. Steroid-induced Pseudomonas aeruginosa endophthalmitis outbreak. J Cataract Refract Surg 2022; 48:113-115. [PMID: 34016823 DOI: 10.1097/j.jcrs.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ritu Arora
- From the Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India (Arora, Goel, Khanam); Department of Microbiology, G B Pant Hospital, New Delhi, India (Loomba)
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9
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Park J, Popovic MM, Balas M, El-Defrawy SR, Alaei R, Kertes PJ. Clinical features of endophthalmitis clusters after cataract surgery and practical recommendations to mitigate risk: systematic review. J Cataract Refract Surg 2022; 48:100-112. [PMID: 34538777 DOI: 10.1097/j.jcrs.0000000000000756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
Intraocular transmission of exogenous pathogens in cataract surgery can lead to endophthalmitis. This review evaluates the features of endophthalmitis clusters secondary to pathogen transmission in cataract surgery. Articles reporting on pathogen transmission in cataract surgery were identified via searches of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL, and a total of 268 eyes from 24 studies were included. The most common source of infectious transmission was attributed to a contaminated intraocular solution (ie, irrigation solution, viscoelastic, or diluted antibiotic; n = 10). Visual acuity at presentation with infectious features was 1.89 logMAR (range: 1.35 to 2.58; ∼counting fingers) and 1.33 logMAR (range: 0.04 to 3.00; Snellen: ∼20/430) at last follow-up. Patients with diabetes had worse outcomes compared with patients without diabetes. The most frequently isolated pathogen from the infectious sources was Pseudomonas sp. (50.0%). This review highlights the various routes of pathogen transmission during cataract surgery and summarizes recommendations for the detection, prevention, and management of endophthalmitis clusters.
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Affiliation(s)
- Jeff Park
- From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Park, Balas); Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Popovic, El-Defrawy, Kertes); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Alaei); Kensington Eye Institute, Toronto, Ontario, Canada (El-Defrawy); John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Canada (Kertes)
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10
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Deb AK, Chavan P, Kaliaperumal S, Sistla S, Madigubba H, Sarkar S, Neena A. Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex. Indian J Ophthalmol 2021; 70:164-170. [PMID: 34937230 PMCID: PMC8917597 DOI: 10.4103/ijo.ijo_1035_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram-negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day-care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia. Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow-up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection.
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Affiliation(s)
- Amit Kumar Deb
- Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Pratima Chavan
- Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Sujatha Sistla
- Department of Microbiology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Haritha Madigubba
- Department of Microbiology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
| | - Aswathi Neena
- Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India
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11
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Cheraqpour K, Ahmadraji A, Tabatabaei SA, Bohrani Sefidan B, Soleimani M, Shahriari M, Ramezani B. Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review. J Int Med Res 2021; 49:3000605211055394. [PMID: 34851772 PMCID: PMC8647252 DOI: 10.1177/03000605211055394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endophthalmitis is the most serious complication of cataract surgery. A cluster
of endophthalmitis is a devastating event for surgeons. Pseudomonas
aeruginosa is the main causative pathogen of Gram-negative
endophthalmitis, which can be suggestive of the occurrence of an outbreak. Ten patients diagnosed with endophthalmitis after cataract surgery performed by
one surgeon were analyzed in this study. At presentation, five patients had
obvious clinical findings of endophthalmitis with visual acuity of light
perception, two patients had poor light perception/no light perception of vision
complicated by concomitant keratitis, and three patients had earlier signs of
infection (e.g., a lower degree of anterior chamber and vitreous cells, better
presenting visual acuity, and greater visibility of the fundus). Investigations
revealed that the source of infection was growth of P.
aeruginosa on the phaco probe. All of the surgeries had been
performed by the same contaminated probe without sterilization between
surgeries. This finding emphasizes the importance of strict adherence to
sterility protocols during high-risk surgeries such as intraocular surgeries.
Additionally, this report aims to emphasize to surgeons that negligence of
simple but vital steps of sterility for any reason, such as limitations in time
or equipment, can lead to catastrophic events.
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Affiliation(s)
- Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ahmadraji
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Bohrani Sefidan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Shahriari
- Imam Hossein Medical Center, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Ramezani
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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12
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Parchand SM, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Agrawal D. Post-cataract surgery cluster endophthalmitis due to multidrug-resistant Pseudomonas aeruginosa: A retrospective cohort study of six clusters. Indian J Ophthalmol 2021; 68:1424-1431. [PMID: 32587182 PMCID: PMC7574127 DOI: 10.4103/ijo.ijo_1612_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To analyze clinical presentations, antibiotic susceptibility, and visual outcomes in six clusters of post cataract surgery endophthalmitis caused due to multidrug-resistant Pseudomonas aeruginosa (MDR-PA). This was a hospital-based retrospective cohort study. Methods: Our study comprised sixty-two patients from six nonconsecutive clusters of post cataract surgery endophthalmitis caused by MDR-PA referred to our tertiary eye care institute. Demographic details, best-corrected visual acuity (BCVA), clinical features, microbiological findings, and patient management were reviewed. Results: The interval between onset of symptoms and presentation ranged from 1 to 7 (mean: 4.61 and median: 5) days. The presenting BCVA was no light perception in 17 (27.4%) eyes, light perception in 35 (56.4%) eyes, and hand movement or better in 10 (16.1%) eyes. All patients had hypopyon and vitreous exudates. Corneal infiltrates were noted in 40 (64.5%) eyes. Panophthalmitis was diagnosed in 20 (32.2%) eyes. The surgical intervention included intraocular antibiotics (IOAB) in 8 (12.9%) eyes, pars plana vitrectomy with IOAB in 26 (41.9%) eyes, and evisceration in 23 (37.09%) eyes. At 6 weeks, BCVA of 20/200 or better was achieved in 9 (14.5%) eyes. Pseudomonas aeruginosa was least resistant to colistin (8.3%), piperacillin (31.8%), and imipenem (36.1%). Ceftriaxone and ceftazidime resistance was seen in 80.5% and 70% isolates, respectively. Conclusion: Cluster endophthalmitis due to MDR-PA has poor visual outcomes with high rates of evisceration. In the setting of cluster endophthalmitis where MDR-PA is the most common etiology, piperacillin or imipenem can be the first drug of choice for empirical intravitreal injection for gram-negative coverage while awaiting the drug susceptibility report.
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Affiliation(s)
- Swapnil M Parchand
- Consultant, Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | - Samrat Chatterjee
- Consultant, Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Anil Gangwe
- Consultant, Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Mihir Mishra
- Consultant, Orbit, Oculoplasty and Ocular Oncology Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Deepshikha Agrawal
- Consultant, Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Mursalin MH, Livingston E, Coburn PS, Miller FC, Astley R, Callegan MC. Intravitreal Injection and Quantitation of Infection Parameters in a Mouse Model of Bacterial Endophthalmitis. J Vis Exp 2021:10.3791/61749. [PMID: 33616100 PMCID: PMC8107885 DOI: 10.3791/61749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intraocular bacterial infections are a danger to the vision. Researchers use animal models to investigate the host and bacterial factors and immune response pathways associated with infection to identify viable therapeutic targets and to test drugs to prevent blindness. The intravitreal injection technique is used to inject organisms, drugs, or other substances directly into the vitreous cavity in the posterior segment of the eye. Here, we demonstrated this injection technique to initiate infection in the mouse eye and the technique of quantifying intraocular bacteria. Bacillus cereus was grown in brain heart infusion liquid media for 18 hours and resuspended to a concentration 100 colony forming units (CFU)/0.5 µL. A C57BL/6J mouse was anesthetized using a combination of ketamine and xylazine. Using a picoliter microinjector and glass capillary needles, 0.5 µL of the Bacillus suspension was injected into the mid vitreous of the mouse eye. The contralateral control eye was either injected with sterile media (surgical control) or was not injected (absolute control). At 10 hours post infection, mice were euthanized, and eyes were harvested using sterile surgical tweezers and placed into a tube containing 400 µL sterile PBS and 1 mm sterile glass beads. For ELISAs or myeloperoxidase assays, proteinase inhibitor was added to the tubes. For RNA extraction, the appropriate lysis buffer was added. Eyes were homogenized in a tissue homogenizer for 1-2 minutes. Homogenates were serially diluted 10-fold in PBS and track diluted onto agar plates. The remainder of the homogenates were stored at -80 °C for additional assays. Plates were incubated for 24 hours and CFU per eye was quantified. These techniques result in reproducible infections in mouse eyes and facilitate quantitation of viable bacteria, the host immune response, and omics of host and bacterial gene expression.
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Affiliation(s)
- Md Huzzatul Mursalin
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center; Department of Ophthalmology, Dean McGee Eye Institute
| | - Erin Livingston
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center
| | - Phillip S Coburn
- Department of Ophthalmology, Dean McGee Eye Institute; Dean McGee Eye Institute
| | - Frederick C Miller
- Department of Cell Biology and Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center
| | - Roger Astley
- Department of Ophthalmology, Dean McGee Eye Institute; Dean McGee Eye Institute
| | - Michelle C Callegan
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center; Department of Ophthalmology, Dean McGee Eye Institute; Dean McGee Eye Institute;
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Patel TP, Zacks DN, Dedania VS. Antimicrobial guide to posterior segment infections. Graefes Arch Clin Exp Ophthalmol 2020; 259:2473-2501. [PMID: 33156370 DOI: 10.1007/s00417-020-04974-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This review article is meant to serve as a reference guide and to assist the treating physician in making an appropriate selection and duration of an antimicrobial agent. METHODS Literature review. RESULTS Infections of the posterior segment require prompt medical or surgical therapy to reduce the risk of permanent vision loss. While numerous options exist to treat these infections, doses and alternative therapies, especially with contraindications for first-line therapy, are often elusive. Antimicrobial agents to treat posterior segment infections can be administered via various routes, including topical, intravitreal, intravenous, and oral. CONCLUSIONS Although there are many excellent review articles on the management of endophthalmitis, we take the opportunity in this review to comprehensively summarize the appropriate antimicrobial regimen of both common and rare infectious etiologies of the posterior segment, using evidence from clinical trials and large case series.
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Affiliation(s)
- Tapan P Patel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Hospital, Baltimore, MD, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Vaidehi S Dedania
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Maleki A, Shahbazi M, Alinezhad V, Santos HA. The Progress and Prospect of Zeolitic Imidazolate Frameworks in Cancer Therapy, Antibacterial Activity, and Biomineralization. Adv Healthc Mater 2020; 9:e2000248. [PMID: 32383250 DOI: 10.1002/adhm.202000248] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/25/2020] [Indexed: 12/27/2022]
Abstract
The progressive development of zeolitic imidazolate frameworks (ZIFs), as a subfamily of metal-organic frameworks (MOFs), and their unique features, including tunable pore size, large surface area, high thermal stability, and biodegradability/biocompatibility, have made them attractive in the field of biomedicine, especially for drug delivery and biomineralization applications. The high porosity of ZIFs gives them the opportunity for encapsulating a high amount of therapeutic drugs, proteins, imaging cargos, or a combination of them to construct advanced multifunctional drug delivery systems (DDSs) with combined therapeutic and imaging capabilities. This review summarizes recent strategies on the design and fabrication of ZIF-based nansystems and their exploration in the biomedical field. First, recent developments for the adjustment of particle size, functionality, and morphology of ZIFs are discussed, which are important for achieving optimized therapeutic/theranostic nanosystems. Second, recent trends on the application of ZIF nanocarriers for the loading of diverse cargos, including anticancer medicines, antibiotic drugs, enzymes, proteins, photosensitizers, as well as imaging and photothermal agents, are investigated in order to understand how multifunctional DDSs can be designed based on the ZIF nanoparticles to treat different diseases, such as cancer and infection. Finally, prospects on the future research direction and applications of ZIF-based nanomedicines are discussed.
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Affiliation(s)
- Aziz Maleki
- Department of Pharmaceutical NanotechnologySchool of PharmacyZanjan University of Medical Sciences Zanjan 45139‐56184 Iran
- Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC)Zanjan University of Medical Sciences Zanjan 45139‐56184 Iran
| | - Mohammad‐Ali Shahbazi
- Department of Pharmaceutical NanotechnologySchool of PharmacyZanjan University of Medical Sciences Zanjan 45139‐56184 Iran
- Drug Research ProgramDivision of Pharmaceutical Chemistry and TechnologyFaculty of PharmacyUniversity of Helsinki Helsinki FI‐00014 Finland
| | - Vajiheh Alinezhad
- Department of Pharmaceutical NanotechnologySchool of PharmacyZanjan University of Medical Sciences Zanjan 45139‐56184 Iran
| | - Hélder A. Santos
- Drug Research ProgramDivision of Pharmaceutical Chemistry and TechnologyFaculty of PharmacyUniversity of Helsinki Helsinki FI‐00014 Finland
- Helsinki Institute of Life SciencesHiLIFEUniversity of Helsinki Helsinki FI‐00014 Finland
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Chen H, Yang J, Sun L, Zhang H, Guo Y, Qu J, Jiang W, Chen W, Ji J, Yang YW, Wang B. Synergistic Chemotherapy and Photodynamic Therapy of Endophthalmitis Mediated by Zeolitic Imidazolate Framework-Based Drug Delivery Systems. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1903880. [PMID: 31588682 DOI: 10.1002/smll.201903880] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/24/2019] [Indexed: 06/10/2023]
Abstract
Endophthalmitis, derived from the infections of pathogens, is a common complication during the use of ophthalmology-related biomaterials and after ophthalmic surgery. Herein, aiming at efficient photodynamic therapy (PDT) of bacterial infections and biofilm eradication of endophthalmitis, a pH-responsive zeolitic imidazolate framework-8-polyacrylic acid (ZIF-8-PAA) material is constructed for bacterial infection-targeted delivery of ammonium methylbenzene blue (MB), a broad-spectrum photosensitizer antibacterial agent. Polyacrylic acid (PAA) is incorporated into the system to achieve higher pH responsiveness and better drug loading capacity. MB-loaded ZIF-8-PAA nanoparticles are modified with AgNO3 /dopamine for in situ reduction of AgNO3 to silver nanoparticles (AgNPs), followed by a secondary modification with vancomycin/NH2 -polyethylene glycol (Van/NH2 -PEG), leading to the formation of a composite nanomaterial, ZIF-8-PAA-MB@AgNPs@Van-PEG. Dynamic light scattering, transmission electron microscopy, and UV-vis spectral analysis are used to explore the nanoparticles synthesis, drug loading and release, and related material properties. In terms of biological performance, in vitro antibacterial studies against three kinds of bacteria, i.e., Escherichia coli, Staphylococcus aureus, and methicillin-resistant S. aureus, suggest an obvious superiority of PDT/AgNPs to any single strategy. Both in vitro retinal pigment epithelium cellular biocompatibility experiments and in vivo mice endophthalmitis models verify the biocompatibility and antibacterial function of the composite nanomaterials.
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Affiliation(s)
- Hao Chen
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou, 32500, China
| | - Jie Yang
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, International Joint Research Laboratory of Nano-Micro Architecture Chemistry (NMAC), College of Chemistry, Jilin University, 2699 Qianjin Street, Changchun, 130012, China
| | - Lin Sun
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hengrui Zhang
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou, 32500, China
| | - Yishun Guo
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jia Qu
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wenya Jiang
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wei Chen
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou, 32500, China
| | - Jian Ji
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Ying-Wei Yang
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, International Joint Research Laboratory of Nano-Micro Architecture Chemistry (NMAC), College of Chemistry, Jilin University, 2699 Qianjin Street, Changchun, 130012, China
| | - Bailiang Wang
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou, 32500, China
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Desai SR, Bhagat PR, Parmar D. Recommendations for an expert team investigating a case of cluster endophthalmitis. Indian J Ophthalmol 2018; 66:1074-1078. [PMID: 30038144 PMCID: PMC6080468 DOI: 10.4103/ijo.ijo_804_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients. Due to its multifactorial etiology, surveillance of such an event is extremely important to identify the causative factor and to prevent recurrences in future. For surveillance, a team of ophthalmologists and microbiologists is often appointed by the local health department, and it is imperative that this team investigates thoroughly, reports appropriately safeguarding the interests of all, and also suggests remedial measures for future. Much literature is available on postoperative endophthalmitis and sterilization and disinfection protocols, but to the best of our knowledge, there is none to guide the surveillance team regarding the conduct of the entire process of investigation in the case of such unfortunate incidents. Through this article, we have made an attempt to formulate recommendations for expert teams investigating cases of postoperative cluster endophthalmitis.
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Affiliation(s)
- Shachi R Desai
- Vitreo-retina surgeon, The Eye Centre, Bodakdev, Ahmedabad, Gujarat, India
| | - Purvi R Bhagat
- Glaucoma Clinic, M & J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
| | - Dipali Parmar
- Cornea Clinic, M & J Western Regional Institute of Ophthalmology, Ahmedabad, Gujarat, India
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Das T. Redefining evidence in the management of acute post-cataract surgery endophthalmitis in India - The 2014 Adenwalla Oration, All India Ophthalmological Society. Indian J Ophthalmol 2017; 65:1403-1406. [PMID: 29208821 PMCID: PMC5742969 DOI: 10.4103/ijo.ijo_755_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current evidence of postoperative endophthalmitis management in three important components of care-infection control, inflammation control, and prevention was reviewed, and their current relevance and application in an Indian context were evaluated. The publications from India indicated that Gram-negative bacterial and filamentous fungal infections are relatively higher. There are increasing instances of resistance to ceftazidime by Gram-negative microorganisms. Intravitreal dexamethasone limits inflammation in bacterial endophthalmitis when given together with the intravitreal antibiotics. Intracameral antibiotic could reduce postcataract surgery infection at least in less rigorous surgical environment. Systematic collection of data and periodic evaluation of the current practice against the new evidence are necessary to prevent or treat postcataract surgery endophthalmitis.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santhamma Center of Vitreo retinal Disease, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Lalitha P, Sengupta S, Ravindran RD, Sharma S, Joseph J, Ambiya V, Das T. A literature review and update on the incidence and microbiology spectrum of postcataract surgery endophthalmitis over past two decades in India. Indian J Ophthalmol 2017; 65:673-677. [PMID: 28820151 PMCID: PMC5598176 DOI: 10.4103/ijo.ijo_509_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: The purpose of this study was to review the incidence and microbiology of acute postcataract surgery endophthalmitis in India. Methods: Systematic review of English-language PubMed referenced articles on endophthalmitis in India published in the past 21 years (January 1992–December 2012), and retrospective chart review of 2 major eye care facilities in India in the past 5 years (January 2010–December 2014) were done. The incidence data were collected from articles that described “in-house” endophthalmitis and the microbiology data were collected from all articles. Both incidence and microbiological data of endophthalmitis were collected from two large eye care facilities. Case reports were excluded, except for the articles on cluster infection. Results: Six of 99 published articles reported the incidence of “in-house” acute postcataract surgery endophthalmitis, 8 articles reported the microbiology spectrum, and 11 articles described cluster infection. The clinical endophthalmitis incidence was between 0.04% and 0.15%. In two large eye care facilities, the clinical endophthalmitis incidence was 0.08% and 0.16%; the culture proven endophthalmitis was 0.02% and 0.08%. Gram-positive cocci (44%-64.8%; commonly, Staphylococcus species), and Gram-negative bacilli (26.2%–43%; commonly Pseudomonas species) were common bacteria in south India. Fungi (16.7%-70%; commonly Aspergillus flavus) were the common organisms in north India. Pseudomonas aeruginosa (73.3%) was the major organism in cluster infections. Conclusions: The incidence of postcataract surgery clinical endophthalmitis in India is nearly similar to the world literature. There is a regional difference in microbiological spectrum. A registry with regular and uniform national reporting will help formulate region specific management guidelines.
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Affiliation(s)
- Prajna Lalitha
- Department of Microbiology Laboratory, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | | | - Savitri Sharma
- Jhaveri Microbiology Laboratory, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Laboratory, Hyderabad, Telangana, India
| | - Vikas Ambiya
- Srimati Kanuri Shantamma Retina Vitreous service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Shantamma Retina Vitreous service, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Ambiya V, Das T, Sharma S, Chhablani J, Dave V, Jalali S, Narayanan R, Joseph J. Comparison of clinico-microbiological profile and treatment outcome of in-house and referred post cataract surgery endophthalmitis in a tertiary care center in South India. J Ophthalmic Inflamm Infect 2016; 6:45. [PMID: 27882513 PMCID: PMC5121114 DOI: 10.1186/s12348-016-0113-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of the study is to compare the clinico-microbiological profile and treatment outcome of in-house vs referred cases of post cataract surgery endophthalmitis in a tertiary eye care facility in South India. Methods The clinical records of 50 culture-positive cases each of in-house (group A) and referred (group B) post cataract surgery endophthalmitis were analyzed. The management protocol was similar in both groups. Results The time to report to the institute was longer in group B (group B 13.63 [±11.67; 95% CI, 9.95–17.31] days; group A 6.83 [±7.61; 95% CI, 4.57–9.09] days; P = 0.002). The average inflammatory scores in presentation were comparable (group A 17.85 ± 5.83; group B 18.18 ± 7.35; P = 0.243). The final visual outcome was clinically superior in group A (≥20/200-group A 60.42% and group B 44%, P = 0.11; ≤20/400-group A 37.5% and group B 52%, P = 0.62), but statistically not significant. There were more gram-positive organisms in group A (62% vs 38%; P = 0.027) and more gram-negative organisms in group B (52% vs 24%; P = 0.007). Gram-positive bacteria were mostly sensitive to vancomycin (95.24% to 96.67%), but gram-negative bacteria were partly sensitive to ceftazidime (58.33% to 64%). Conclusions One could suspect gram-negative infection more often in the referred cases of endophthalmitis. While vancomycin could continue to be the antibiotic of choice in gram-positive bacteria, specific antibiotic following due sensitivity for gram-negative bacteria should replace the empiric use of ceftazidime.
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Affiliation(s)
- Vikas Ambiya
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India. .,LV Prasad Eye Institute, Road No. 2, LV Prasad Marg, Banjara Hills, Hyderabad, 500034, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, Brien Holden Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Jay Chhablani
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Dave
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Raja Narayanan
- Srimati Kanuri Santhamma Retina Vitreous Center, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Research Center, LV Prasad Eye Institute, Hyderabad, India
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Falavarjani KG, Alemzadeh SA, Habibi A, Hadavandkhani A, Askari S, Pourhabibi A. Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities. Ocul Immunol Inflamm 2016; 25:377-381. [DOI: 10.3109/09273948.2015.1132740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Khalil Ghasemi Falavarjani
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | | | - Abbas Habibi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Hadavandkhani
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sareh Askari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Pourhabibi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Khanna RC, Ray VP, Latha M, Cassard SD, Mathai A, Sekhar GC. Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India. Int J Ophthalmol 2015; 8:1184-9. [PMID: 26682170 DOI: 10.3980/j.issn.2222-3959.2015.06.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/09/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.
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Affiliation(s)
- Rohit C Khanna
- LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500062, India
| | - Vanita Pathak Ray
- LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500062, India
| | - Madhavi Latha
- LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500062, India
| | - Sandra D Cassard
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | - Annie Mathai
- LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500062, India
| | - Garudadri C Sekhar
- LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500062, India
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ENDOPHTHALMITIS CAUSED BY PSEUDOMONAS AERUGINOSA: Clinical Features, Antibiotic Susceptibilities, and Treatment Outcomes. Retina 2015; 35:1101-6. [PMID: 25658178 DOI: 10.1097/iae.0000000000000469] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the clinical features, antibiotic susceptibilities, and visual outcomes associated with endophthalmitis caused by Pseudomonas aeruginosa. METHODS A consecutive case series. Microbiology database records were retrospectively reviewed for all patients with endophthalmitis caused by P. aeruginosa from January 1, 2002, to December 31, 2012, at a large university referral center. The corresponding clinical records were then reviewed to evaluate the endophthalmitis clinical features and treatment outcomes. RESULTS In the 12 patients identified, clinical settings included postcataract surgery (n = 4), postpenetrating keratoplasty (n = 3), endogenous source (n = 2), post-pars plana vitrectomy (n = 1), trabeculectomy bleb-associated setting (n = 1), and glaucoma drainage implant-associated setting (n = 1). All patients presented with hypopyon. Presenting visual acuity was hand motions or worse in all cases. All isolates were susceptible to ceftazidime and levofloxacin. When comparing isolates in this study with isolates from a previous study (1987 to 2001), the minimal inhibitory concentration required to inhibit 90% of isolates (MIC 90, in micrograms per milliliter) remained the same for ceftazidime (8), ciprofloxacin (0.5), imipenem (4), tobramycin (0.5), and amikacin (4). Initial treatment strategies were vitreous tap and injection (n = 9) and pars plana vitrectomy with intravitreal antibiotics (n = 3). Final visual acuity was light perception or worse in 11 of the 12 patients (92%). Five patients underwent enucleation (42%). CONCLUSION All isolates were susceptible to ceftazidime and levofloxacin, and all MIC 90s for isolates in the current period compared with isolates from 1987 to 2001 remained identical. Despite early and appropriate treatment, outcomes were generally poor with a high rate of enucleation.
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Kessel L, Flesner P, Andresen J, Erngaard D, Tendal B, Hjortdal J. Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta-analysis. Acta Ophthalmol 2015; 93:303-17. [PMID: 25779209 PMCID: PMC6680152 DOI: 10.1111/aos.12684] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one randomized trial and one observational study. The quality and design of the included studies were analysed using the Cochrane risk of bias tool. The quality of the evidence was evaluated using the GRADE approach. We found high-to-moderate quality evidence for a marked reduction in the risk of endophthalmitis with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one of 485 surgeries when intracameral antibiotics were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.12 (0.08; 0.18) when intracameral antibiotics were used. The difference was highly significant (p < 0.00001). Intracameral antibiotic therapy is the best choice for preventing endophthalmitis after cataract surgery. We did not find evidence to conclude that topical antibiotic therapy prevents endophthalmitis.
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Affiliation(s)
- Line Kessel
- Department of OphthalmologyCopenhagen University Hospital GlostrupGlostrupDenmark
- Danish Health and Medicines AuthoritiesCopenhagenDenmark
| | | | | | - Ditte Erngaard
- Department of OphthalmologyNæstved HospitalNæstvedDenmark
| | - Britta Tendal
- Danish Health and Medicines AuthoritiesCopenhagenDenmark
| | - Jesper Hjortdal
- Department of OphthalmologyAarhus University Hospital NBGAarhusDenmark
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Bispo PJM, Haas W, Gilmore MS. Biofilms in infections of the eye. Pathogens 2015; 4:111-36. [PMID: 25806622 PMCID: PMC4384075 DOI: 10.3390/pathogens4010111] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/27/2022] Open
Abstract
The ability to form biofilms in a variety of environments is a common trait of bacteria, and may represent one of the earliest defenses against predation. Biofilms are multicellular communities usually held together by a polymeric matrix, ranging from capsular material to cell lysate. In a structure that imposes diffusion limits, environmental microgradients arise to which individual bacteria adapt their physiologies, resulting in the gamut of physiological diversity. Additionally, the proximity of cells within the biofilm creates the opportunity for coordinated behaviors through cell–cell communication using diffusible signals, the most well documented being quorum sensing. Biofilms form on abiotic or biotic surfaces, and because of that are associated with a large proportion of human infections. Biofilm formation imposes a limitation on the uses and design of ocular devices, such as intraocular lenses, posterior contact lenses, scleral buckles, conjunctival plugs, lacrimal intubation devices and orbital implants. In the absence of abiotic materials, biofilms have been observed on the capsule, and in the corneal stroma. As the evidence for the involvement of microbial biofilms in many ocular infections has become compelling, developing new strategies to prevent their formation or to eradicate them at the site of infection, has become a priority.
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Affiliation(s)
- Paulo J M Bispo
- Departments of Ophthalmology, Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114 USA
| | - Wolfgang Haas
- Departments of Ophthalmology, Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114 USA
| | - Michael S Gilmore
- Departments of Ophthalmology, Microbiology and Immunology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114 USA.
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Lakshmi Priya J, Prajna L, Mohankumar V. Genotypic and phenotypic characterization of Pseudomonas aeruginosa isolates from post-cataract endophthalmitis patients. Microb Pathog 2015; 78:67-73. [DOI: 10.1016/j.micpath.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/08/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022]
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Galor A, Goldhardt R, Wellik SR, Gregori NZ, Flynn HW. Management strategies to reduce risk of postoperative infections. CURRENT OPHTHALMOLOGY REPORTS 2013; 1. [PMID: 24319649 DOI: 10.1007/s40135-013-0021-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17 Street, Miami, FL, 33136
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Eguchi H, Miyamoto T, Kuwahara T, Mitamura S, Mitamura Y. Infectious conjunctivitis caused by Pseudomonas aeruginosa isolated from a bathroom. BMC Res Notes 2013; 6:245. [PMID: 23815865 PMCID: PMC3702478 DOI: 10.1186/1756-0500-6-245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 06/25/2013] [Indexed: 11/15/2022] Open
Abstract
Background The elucidation of the routes of transmission of a pathogen is crucial for the prevention of infectious diseases caused by bacteria that are not a resident in human tissue. The purpose of this report is to describe a case of suture-related conjunctivitis caused by Pseudomonas aeruginosa for which we identified the transmission route using pulsed-field gel electrophoresis (PFGE). Case presentation A 38-year-old man, who had undergone surgery for glaucoma 2 years ago previously, presented with redness, discomfort, and mucopurulent discharge in the right eye. A 9–0 silk suture had been left on the conjunctiva. A strain of P. aeruginosa was isolated from a culture obtained from the suture, and the patient was therefore diagnosed with suture-related conjunctivitis caused by P. aeruginosa. The conjunctivitis was cured by the application of an antimicrobial ophthalmic solution and removal of the suture. We used PFGE to survey of the indoor and outdoor environments around the patient’s house and office in order to elucidate the route of transmission of the infection. Three strains of P. aeruginosa were isolated from the patient’s indoor environment, and the isolate obtained from the patient’s bathroom was identical to that from the suture. Conclusion The case highlights the fact that an indoor environmental strain of P. aeruginosa can cause ocular infections.
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Agrawal R, Laude A. Contaminated intraocular lens solution. Ophthalmology 2012; 119:2417-8; author reply 2418. [PMID: 23122472 DOI: 10.1016/j.ophtha.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022] Open
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Shoaib KK. Endophthalmitis due to IOL solution. Ophthalmology 2012; 119:1940; author reply 1940-1. [PMID: 22944502 DOI: 10.1016/j.ophtha.2012.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022] Open
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Role of inflammation in endophthalmitis. Mediators Inflamm 2012; 2012:196094. [PMID: 22973073 PMCID: PMC3438776 DOI: 10.1155/2012/196094] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/29/2012] [Indexed: 11/17/2022] Open
Abstract
Inflammation originating from infection of the vitreous cavity is called endophthalmitis. Attention has been focused on the epidemiologic, microbiologic reports, and treatment options; unfortunately, the role of the host immune reaction in the visual function damage is still not well understood. Endophthalmitis occurs most frequently after cataract surgery. In this paper we review the published literature regarding inflammatory mediators and apoptosis during the course of endophthalmitis. Toll-like receptors, cytokines, high-mobility group box 1 proteins, aB-crystallin and apoptosis have been studied during clinical and experimental cases of endophthalmitis. Further understanding of the host-immune reaction to vitreous infection is essential for the development of new therapies. The use of intravitreal antibiotics and corticosteroids, vitrectomy and systemic antibiotics for the preservation of visual function is still discouraging.
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Majji AB, Ramappa M, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A, Gopinathan U, Garg P. Author reply. Ophthalmology 2012. [DOI: 10.1016/j.ophtha.2012.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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