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Łątkowska M, Gajdzis M, Turno-Kręcicka A, Kręcicka J, Mimier-Janczak M, Górczyńska I, Kaczmarek R. Sudden Vision Loss as the First Sign of Sepsis-Bilateral Endogenous Endophthalmitis of Uncommon Capnocytophaga canimorsus Etiology. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:896. [PMID: 38929513 PMCID: PMC11205361 DOI: 10.3390/medicina60060896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
We present a case of bilateral endogenous endophthalmitis with an extremely rare etiology of Capnocytophaga canimorsus. A 42-year-old asplenic patient with bilateral deterioration of visual acuity presented to the Emergency Department. The sudden deterioration of visual acuity, which prompted the patient to visit the ophthalmologist, was the first sign of the onset of sepsis. The physicians' attention, in addition to poor visual acuity and intense inflammation on ophthalmologic examination, was drawn to the reported flu-like symptoms. They were accompanied by high C-reactive protein results and abnormalities in echocardiography. A blood culture isolated the bacterium Capnocytophaga canimorsus. Immunocompromised patients are particularly susceptible to C. canimorsus infection. Endophthalmitis of this etiology has a very aggressive course, both ophthalmic and systemic. Therefore, quick diagnosis and initiation of adequate therapy are crucial.
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Affiliation(s)
- Małgorzata Łątkowska
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
| | - Małgorzata Gajdzis
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Anna Turno-Kręcicka
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Julia Kręcicka
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
| | | | - Izabela Górczyńska
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
| | - Radosław Kaczmarek
- Department of Ophthalmology, University Clinical Hospital, 50-556 Wrocław, Poland
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
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2
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Aftab OM, Dupaguntla A, Khan H, Uppuluri A, Zarbin MA, Bhagat N. Regional Variation of Infectious Agents Causing Endogenous Endophthalmitis in the United States: A National Database Analysis. Ophthalmol Retina 2024:S2468-6530(24)00116-7. [PMID: 38492775 DOI: 10.1016/j.oret.2024.03.012] [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: 11/28/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe regional variation in microbes causing infectious endogenous endophthalmitis (EE) in the United States. DESIGN This is a retrospective, national database analysis utilizing the 2002-2014 National Inpatient Sample database. SUBJECTS Using the International Classification of Disease 9 codes, we identified cases with EE. Cases were stratified regionally into Northeast, South, West, or Midwest. METHODS Unadjusted chi-square analysis followed by adjusted multivariate logistic regression was performed to evaluate variation in demographic factors, comorbidities using the Elixhauser Comorbidity Index (ECI), microbial variation, mortality, and use of vitrectomy or enucleation by region. MAIN OUTCOME MEASURES Proportion of microbes, mortality, and vitrectomy by region in addition to factors with significant odds ratios for mortality and for in-hospital vitrectomy. RESULTS A total of 10 912 patients with infectious EE were identified, with 2063 cases in the Northeast (18.9%), 2145 cases in the Midwest (19.7%), 4134 cases in the South (37.9%), and 2570 cases in the West (23.6%). Chi-square analysis indicated significant regional variation in patient demographics, microbes causing the infection, ECI, mortality, and surgical intervention. The 4 most common microbes for all regions were methicillin-sensitive Staphylococcus aureus (MSSA), Streptococcus, Candida, and methicillin-resistant Staphylococcus aureus. Methicillin-sensitive S. aureus was the most common cause of EE in all regions, although the proportion of MSSA infection did not significantly vary by region (P = 0.03). Further, there was significant regional variation in the proportion of other microbes causing the infection (P < 0.001). Higher rates of vitrectomies were seen in the South and Midwest regions than that in the Northeast and West (P = 0.04). CONCLUSIONS Regional variation exists in the infectious microbes causing EE. Further studies are needed to elucidate the etiology of these variations. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Owais M Aftab
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anup Dupaguntla
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hamza Khan
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Aditya Uppuluri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marco A Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Agi N, Zarbin MA, Bhagat N. Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic. JOURNAL OF VITREORETINAL DISEASES 2023; 7:316-321. [PMID: 37920850 PMCID: PMC10170248 DOI: 10.1177/24741264231170462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.
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Affiliation(s)
- Nathan Agi
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Sciences, Rutgers University–New Jersey Medical School, Newark, NJ, USA
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4
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Flynn E, Lesche S, Ittoop S, Mansour T, Barak S, Wroblewski KJ. MRSA panophthalmitis in a brittle diabetic. J Ophthalmic Inflamm Infect 2023; 13:19. [PMID: 37069286 PMCID: PMC10110829 DOI: 10.1186/s12348-023-00344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Erin Flynn
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA
| | - Stephen Lesche
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA
| | - Sabita Ittoop
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA
| | - Tamer Mansour
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA
| | - Stephanie Barak
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA
| | - Keith James Wroblewski
- Department of Ophthalmology, George Washington University, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, 20037, USA.
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Thangamathesvaran L, Canner JK, Scott AW, Woreta FA, Breazzano MP. National emergency department trends for endogenous endophthalmitis: an increasing public health challenge. Eye (Lond) 2023; 37:1123-1129. [PMID: 35487961 PMCID: PMC10102014 DOI: 10.1038/s41433-022-02080-9] [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] [Received: 11/01/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE To characterize incidence rates and identify risk factors for admission and mortality in patients with endogenous endophthalmitis (EE) in the United States (US). SUBJECTS/METHODS Patients with EE were identified using the Nationwide Emergency Department (NEDS) Database from 2006 to 2017 in this cross-sectional study. Subjects were required to have diagnoses of both endophthalmitis and septicaemia using contemporary International Classification of Diseases diagnosis codes. Incidence rates, mortality rates and demographics were evaluated. Risk factors for admission and mortality were identified using weighted logistic regression analysis. RESULTS A total of 6400 patients with EE were identified. Incidence increased from 0.10 (95% confidence interval [CI]: 0.07-0.12) per 100,000 in the US population in 2006 to 0.25 (95% CI: 0.21-0.30) in 2017 (p < 0.05). Most were female (55.4%), insured with Medicare (53.5%), were in the first income quartile earnings (29.3%) [bottom 25% income bracket], lived in the South (40.5%), and presented to metropolitan teaching hospitals (66.6%). Mortality increased from 8.6% (95% CI: 3.8-18.3%) in 2006 to 13.8% (95% CI: 9.7-19.2%) in 2017 (p = 0.94). Factors predicting admission included older age (odds ratio [OR] 32.59; [95% CI 2.95-359.78]) and intravenous drug use (OR 14.90 [95% CI: 1.67-133.16]). Factors associated with increased mortality included: human immunodeficiency virus infection/immune deficiencies (OR 2.58 [95% CI: 1.26-5.28]), heart failure (OR 2.12 [95% CI: 1.47-3.05]), and hepatic infections/cirrhosis (OR 1.89 [95% CI: 1.28-2.79]). Pneumonia and renal/urinary tract infections (UTI) were associated with both increased hospital admission [(pneumonia OR 9.64 (95% CI: 1.25-74.35, p = 0.030), renal/UTI OR 4.09 (95% CI: 1.77-9.48)] and mortality [(pneumonia OR 1.64 (95% CI: 1.17-2.29, p = 0.030), renal/UTI OR 1.87 (95% CI: 1.18-2.97)]. Patients with diabetes mellitus (DM) had decreased odds ratio for mortality (OR 0.49 [95% CI: 0.33-0.73]). CONCLUSION EE has increased in incidence throughout US. The two systemic factors that conferred both an increase in mortality and admission were pneumonia, and renal/UTI. Additional exploration of the potential protective association of DM with decreased mortality in this context is needed.
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Affiliation(s)
- Loka Thangamathesvaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adrienne W Scott
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY, USA.
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Sasi S, Faraj H, Barazi R, Kolleri J, Chitrambika P, Rahman Al Maslamani MA, Ali M. Endogenous endophthalmitis due to Serratia marcescens secondary to late-onset empyema Post-Cardiac surgery in an End-Stage renal disease patient on peritoneal dialysis. Clin Case Rep 2023; 11:e6997. [PMID: 36852121 PMCID: PMC9957995 DOI: 10.1002/ccr3.6997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/18/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023] Open
Abstract
Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital-acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end-stage renal disease (ESRD) on peritoneal dialysis, who had late-onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61-year-old gentleman presented with a two-day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high-dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long-term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital-acquired, and the source can be late-onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.
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Affiliation(s)
- Sreethish Sasi
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Hazem Faraj
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Raja Barazi
- Department of PharmacyHamad Medical CorporationDohaQatar
| | - Jouhar Kolleri
- Department of Clinical ImagingHamad Medical CorporationDohaQatar
| | - P. Chitrambika
- Department of AnesthesiologyHamad Medical CorporationDohaQatar
| | | | - Maisa Ali
- Infectious Diseases Division, Department of Internal MedicineHamad Medical CorporationDohaQatar
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7
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Nanayakkara U, Khan MA, Hargun DK, Sivagnanam S, Samarawickrama C. Ocular streptococcal infections: A clinical and microbiological review. Surv Ophthalmol 2023:S0039-6257(23)00036-X. [PMID: 36764397 DOI: 10.1016/j.survophthal.2023.02.001] [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: 02/27/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Streptococcus is a diverse bacterial genus that is part of the ocular surface microbiome implicated in conjunctivitis, keratitis, endophthalmitis, dacryocystitis, and orbital cellulitis which can lead to decreased visual acuity and require surgical intervention. The pathophysiology of S. pneumoniae is well established and the role of the polysaccharide capsule, pneumolysin, neuraminidases, and zinc metalloproteinases in ocular infections described. Additionally, key virulence factors of the viridans group streptococci such as cytolysins and proteases have been outlined, but there is a paucity of research on the remaining streptococcus species. These virulence factors tend to result in aggressive disease. Clinically, S. pneumoniae is implicated in 2.7-41.2% of bacterial conjunctivitis cases, more predominant in the pediatric population, and is implicated in 1.8-10.7% of bacterial keratitis isolates. Streptococcus bacteria are significantly implicated in acute postoperative, post-intravitreal, and bleb-associated endophthalmitis, responsible for 10.3-37.5, 29.4, and 57.1% of cases, respectively. Group A and B streptococcus endogenous endophthalmitis is rare, but has a very poor prognosis. Inappropriate prescription of antibiotics in cases of non-bacterial aetiology has contributed to increasing resistance, and a clinical index is needed to more accurately monitor this. Furthermore, there is an increasing need for prospective, surveillance studies of antimicrobial resistance in ocular pathogens, as well as point-of-care testing using molecular techniques.
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Affiliation(s)
| | | | | | - Shobini Sivagnanam
- Blacktown Hospital, Sydney, Australia; Australian Clinical Labs, Bella Vista, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney, Australia; Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute for Medical Research, Australia.
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8
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Zhang X, Brodie FL, Postel EA, Seidelman JL. Endogenous Methicillin-Resistant Staphylococcus Aureus (MRSA) Endophthalmitis: A Six-year Series at a Tertiary Care Center. Ocul Immunol Inflamm 2022; 30:1572-1576. [PMID: 33945390 DOI: 10.1080/09273948.2021.1906911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the clinical outcomes of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis. METHODS Clinical courses were reviewed for 17 eyes (15 patients) with endogenous MRSA endophthalmitis based on positive blood and vitreous culture or clinical suspicion between 2013 to 2019 at Duke University Hospitals. RESULTS Of 17 eyes, initial VA ranged from 20/40 to light perception. Of 15 patients, 9 had predisposing risk factors for bacteremia. All eyes received intravitreal vancomycin, 13 also received ceftazidime, and 2 also received amikacin instead of ceftazidime. Nine eyes developed retinal detachment; 6 underwent vitrectomy. Final VA ranged from 20/20 to no light perception and was ≥20/200 in 8 eyes. Eleven eyes had improved VA, 2 eyes were unchanged, and 4 were worse. CONCLUSIONS This study is the largest series on endogenous MRSA endophthalmitis to date. Patients had a higher proportion of final VA ≥20/200, similarly high rate of RD, and fewer enucleations compared to prior reports.
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Affiliation(s)
- Xinxin Zhang
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Frank L Brodie
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Eric A Postel
- Duke University Eye Center, Duke University, Durham, North Carolina, USA
| | - Jessica L Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina, USA
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9
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Chen N, Chalam KV. Successful management of a rare case of endogenous endophthalmitis from soft tissue (gluteal) abscess. J Surg Case Rep 2022; 2022:rjac412. [PMID: 36148144 PMCID: PMC9487197 DOI: 10.1093/jscr/rjac412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Endophthalmitis, an ophthalmic emergency carries poor visual prognosis without prompt diagnosis and treatment. Endophthalmitis is often exogenous and rarely endogenous. In this report, we describe a rare case of bacterial endogenous endophthalmitis in an immunocompetent 51-year-old patient due to methicillin-resistant staphylococcus aureus septicemia from a gluteal abscess. Ultrasonography confirmed endogenous endophthalmitis. The patient was treated with immediate intravitreal antibiotic injections, prolonged intravenous antibiotics in association with pars plana vitrectomy, retinal detachment repair and vitreous debris removal. Successful treatment was confirmed with negative blood cultures and a clear vitreous on b-scan ultrasound and fundus photography with improvement of his visual acuity. This case highlights the importance of consideration of rare infectious foci as etiology and prompts treatment for successful resolution of endogenous endophthalmitis.
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Affiliation(s)
- Natalie Chen
- Department of Ophthalmology, Loma Linda University School of Medicine , Loma Linda, CA, USA
| | - K V Chalam
- Department of Ophthalmology, Loma Linda University School of Medicine , Loma Linda, CA, USA
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Uppuluri A, Zarbin MA, Bhagat N. Trends in Endogenous Endophthalmitis in Rural and Urban Settings in the United States. Ophthalmic Epidemiol 2022; 30:300-306. [PMID: 35848205 DOI: 10.1080/09286586.2022.2094965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The objective of this study is to explore and compare trends in urban and rural cases of endogenous endophthalmitis (EE) in the United States. METHODS This study utilizes data from the 2002-2014 National Inpatient Sample (NIS) Database. Disease diagnoses and procedures were identified using codes from the International Classification of Diseases, Ninth Revision (ICD-9). Cases of EE were defined as cases of endophthalmitis in the setting of bacteremia or candidemia without a recent history of ocular trauma. The NIS Database defines urban and rural hospitals based on the hospital county's population statistics. Statistical analysis was performed using IBM SPSS 23. RESULTS We identified 8255 cases of EE. Of these cases, 523 (6.3%) occurred in rural areas; 7733 (93.7%) occurred in urban areas. Of the cases of EE, 7692 (93.2%) were bacterial EE, 412 (5.0%) were candida EE, and 151 (1.8%) were mixed EE. Candida EE was observed in 1.7% of rural cases and 5.2% of urban cases (p < .001). Pars plana vitrectomies were performed more often in urban hospitals than in rural hospitals (11.5% vs. 2.9%; p < .001). CONCLUSION Endogenous endophthalmitis remains a rare but devastating ocular infection. In this study, we have demonstrated that there are important differences in cases of EE that present to urban and rural hospitals. Future investigations into these differences in patient demographics, source/systemic infections, and hospital courses may allow clinicians and hospitals to develop a more targeted approach to treating EE based on the type of community from which the patient presents.
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Affiliation(s)
- Aditya Uppuluri
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Zarbin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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11
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Conlon P, Creedon M, Houlihan E, O'Rourke S. Complexities in diagnosing and treating endophthalmitis in the post stem cell transplant setting. BMJ Case Rep 2022; 15:e250552. [PMID: 35725282 PMCID: PMC9214367 DOI: 10.1136/bcr-2022-250552] [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: 06/07/2022] [Indexed: 11/04/2022] Open
Abstract
Endophthalmitis is a rare but sight-threatening manifestation of systemic infection. Immunosuppression is a well-recognised risk factor for development of endophthalmitis. Determining the aetiology can be complex, particularly in the context of immunosuppression, we present the diagnostic and treatment dilemmas associated with a patient who complains of blurred vision 2 weeks following an allogeneic stem cell transplant for refractory Hodgkin's disease. We demonstrate that in the context of immunosuppression post stem cell transplantation, a broad differential should be maintained until a microbiological diagnosis can be confirmed. In particular, we evaluate how clinical suspicion can diverge from typical fundoscopic findings in the diagnosis of endophthalmitis.
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Affiliation(s)
- Peter Conlon
- Haematology Department, St James' Hospital, Dublin, Ireland
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12
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Brotherton T, Nwankwo E, Das D, Fritz A. Endogenous endophthalmitis due to methicillin-resistant Staphylococcus aureus bacteremia in a patient with COVID-19. Proc AMIA Symp 2021; 35:197-198. [DOI: 10.1080/08998280.2021.1990823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tim Brotherton
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
| | - Eugene Nwankwo
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
| | - Debapria Das
- Department of Cardiology, Saint Louis University Hospital, Saint Louis, Missouri
| | - Adam Fritz
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri
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13
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Budoff G, Zarbin MA, Bhagat N. Endogenous Endophthalmitis in an Urban University Setting: Characteristics, Treatment, and Outcomes. JOURNAL OF VITREORETINAL DISEASES 2021; 5:135-141. [PMID: 37009077 PMCID: PMC9979060 DOI: 10.1177/2474126420951979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work describes the characteristics, treatment, and outcomes of endogenous endophthalmitis (EE) cases over 13 years at a tertiary care hospital. Methods: This retrospective case series included EE cases from 2006 to 2018. Eyes were categorized by cultured organism and initial treatment status. Results: Forty-five eyes of 38 patients were identified with EE. Mean age was 48 ± 12 years and approximately three-fourths were male. Mean visual acuity (VA) at presentation was logMAR 1.86 ± 0.83. More than 50% of patients had a history of intravenous drug use. In a quarter of patients, no systemic source of infection was identified; 90% of these patients had a history of intravenous drug use. Bilateral infections occurred in 18% of participants. Of positive cultures, 29%, 56%, and 13% were fungal, gram-positive, and gram-negative in etiology, respectively. Eyes with fungal infections had a better presenting VA and were more likely to have better than 20/100 final VA vs those with bacterial infections. All patients received IV antibiotics; additionally 29% of eyes underwent initial combined pars plana vitrectomy with intravitreal antibiotic injection while 51% of eyes initially received bedside intravitreal antibiotic injection. There was no significant difference in final VA with respect to initial mode of treatment. Conclusions: Initial treatment of intravitreal antibiotics with or without pars plana vitrectomy did not show any difference in the average final VA in eyes with EE. Eyes with fungal infections had more favorable visual outcomes than those with bacterial infections. Almost 1 in 5 EE eyes were enucleated.
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Affiliation(s)
- Greg Budoff
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
- Stein Eye Institute, University of California, Los Angeles, CA, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, NJ, USA
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14
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Endogenous endophthalmitis in patients with intravenous opioid use: demographics and associated comorbidities. Int Ophthalmol 2021; 41:1513-1520. [PMID: 33506370 DOI: 10.1007/s10792-021-01709-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/09/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify risk factors for endogenous endophthalmitis (EE) in hospitalized adults, under 65 years of age, with a history of intravenous opioid use and non-ocular infection. METHODS The National Inpatient Sample Database was used to identify cases of EE with a recent history of intravenous opioid use disorder with associated non-ocular infection. Systemic and ocular comorbidities were identified using codes from the International Classification of Diseases, Ninth Revision (ICD-9). Descriptive and regression analyses were performed to evaluate the risk factors for EE using IBM SPSS 23. RESULTS Of the 605,859 inpatients, 21-65 years age, who had a history of recent opioid-IVDU and an associated IVDU-associated systemic infection, 363 (0.1%) had EE. Systemic comorbidities such as diabetes mellitus, mitral valve disease, aortic valve disease, history of cardiac valve transplantation, chronic kidney disease/renal failure, cirrhosis, active or previous radiation therapy, and history of solid organ transplantation were significantly more prevalent in patients with EE. A significantly increased risk of EE in intravenous opioid users was noted if they were of male gender (OR = 1.84), Asian/Pacific Islander ethnicity (OR = 4.41), had history of cirrhosis (OR = 2.33), active or history of radiation therapy (OR = 14.74), history of solid organ transplantation (OR = 5.91), candidemia (OR = 15.22), and infectious endocarditis (OR = 4.83). Conversely, concurrent alcohol use disorder (OR = 0.35) decreased the risk of EE. CONCLUSION Various demographic variables and systemic comorbidities increased the risk of developing EE in inpatients with a history of intravenous opioid use with associated non-ocular infection.
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Uppuluri A, Zarbin MA, Budoff G, Bhagat N. Risk Factors for Endogenous Endophthalmitis in Hospitalized Patients with Candida Fungemia. Ophthalmol Retina 2020; 5:687-695. [PMID: 33075547 DOI: 10.1016/j.oret.2020.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/19/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To use the 2002 through 2014 National Inpatient Sample (NIS) database to identify risk factors for endogenous endophthalmitis (EE) in hospitalized patients with candidemia. DESIGN Retrospective, cross-sectional study. PARTICIPANTS Hospitalized patients sampled in the NIS database. METHODS The NIS database (2002-2014) was used to identify patients with candidemia and EE and their comorbidities. Descriptive analysis was performed with chi-square testing, and risk factors for EE were identified using logistic regression analysis. Chi-square testing and regression analysis were performed using IBM SPSS software version 23 (IBM Corp, Armonk, NY) and R package software version 3.4.3 (R Foundation for Statistical Computing, Vienna, Austria), respectively. MAIN OUTCOME MEASURE Diagnosis of EE in hospitalized patients with candidemia. RESULTS We identified 98 783 hospitalized patients with candidemia; 529 patients (0.5%) had concurrent EE. Men constituted 48.0% of patients who did not demonstrate EE and 45.1% of those who did (P = 0.186). The average age of fungemia patients with EE was 54.6 years and of those without EE was 58.2 years (P < 0.001). Most EE cases (58.6%) occurred in patients 21 to 64 years of age. Hispanic (odds ratio [OR], 1.58), Asian or Pacific Islander (OR, 3.51), and Native American (OR, 5.22) patients with candidemia were at an increased risk of EE developing compared with White patients. Candida endocarditis (OR, 1.84), cirrhosis (OR, 1.93), diabetes with chronic complications (OR, 1.96), intravenous drug use (OR, 3.12), radiation therapy (OR, 5.28), and solid organ transplantation (OR, 2.48) increased the risk of seeding the infection into the eye. Conversely, chronic kidney disease (OR, 0.53) and invasive mechanical intubation (OR, 0.43) were associated with a decreased risk of EE. The mortality of inpatients with candidemia was significantly lower in the EE group (2.8% vs. 15.6%; P < 0.001). CONCLUSIONS Systemic comorbidities that increased the risk of EE in candidemia included endocarditis, cirrhosis, diabetes with chronic complications, intravenous drug use, radiation therapy, and solid organ transplantation. Racial disparity was observed with Hispanics, Asians and Pacific Islanders, and Native Americans at a higher risk than Whites of being diagnosed with EE in the setting of Candida fungemia.
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Affiliation(s)
- Aditya Uppuluri
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marco A Zarbin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Greg Budoff
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neelakshi Bhagat
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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