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Ortega-Prades G, Pérez-Torregrosa VT, Carot-Sanmillán H, Cifre-Fabra Y, Ruíz-Del Río N, Duch-Samper AM. Citrobacter koseri, an unusual exogenous endoftalmitis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:82-86. [PMID: 38211828 DOI: 10.1016/j.oftale.2024.01.002] [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: 08/24/2023] [Accepted: 11/12/2023] [Indexed: 01/13/2024]
Abstract
Citrobacter koseri is a bacillus that causes infrequent endophthalmitis. 6% of cultures in endophthalmitis are Gram -, and as in these, C. koseri is associated with a poor visual prognosis. We present a 65-year-old man who works in an animal laboratory. He went to emergencies with loss of vision in his left eye due to a vitreous hemorrhage. A vitrectomy was performed and 3 days later, endophthalmitis was diagnosed. Vancomycin and Ceftazidime were applied in eye drops and in two intravitreal injections. 24 h later he returned with a lens extrusion. Due to the severity of the condition, an evisceration was performed. Subsequently, the samples confirm the microorganism. We assume that the entry point for the bacterium was the sclerotomies through the exposed suture material, after handling rodent feces.
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Affiliation(s)
- G Ortega-Prades
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - V-T Pérez-Torregrosa
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - H Carot-Sanmillán
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Y Cifre-Fabra
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - N Ruíz-Del Río
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - A-M Duch-Samper
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Das T, Joseph J, Simunovic MP, Grzybowski A, Chen KJ, Dave VP, Sharma S, Staropoli P, Flynn H. Consensus and controversies in the science of endophthalmitis management: Basic research and clinical perspectives. Prog Retin Eye Res 2023; 97:101218. [PMID: 37838286 DOI: 10.1016/j.preteyeres.2023.101218] [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: 07/25/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
Infectious endophthalmitis is a severe intraocular infection caused by bacteria, or less commonly by fungi. It can occur after penetrating eye procedures, trauma, or the spread of infection from contiguous structures or via emboli from distant organs. Because of the time-critical nature of the treatment, endophthalmitis is treated with the clinical diagnosis and modified by the microbiological report of the intraocular contents. The current strategy for managing endophthalmitis relies on pre-clinical literature, case series, and one large multi-center randomized clinical trial on post-cataract surgery endophthalmitis. Culture-susceptibility of the microorganisms from undiluted vitreous guides the definitive treatment in non-responsive cases. Strategies to reduce the incidence of endophthalmitis after penetrating eye procedures have been developed concurrently with refined means of treatment. Despite these advances, outcomes remain poor for many patients. Although consensus articles have been published on managing endophthalmitis, treatment patterns vary, and controversies remain. These include (1) the use of newer methods for early and precise microbiological diagnosis; (2) the choice of intravitreal antibiotics; (3) the need for systemic therapy; (4) early and complete vitrectomy. Here, we review the current consensus and address controversies in diagnosing and managing endophthalmitis. This review is intended to familiarize physicians and ophthalmologists with different aspects of endophthalmitis management to make informed decisions.
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Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V, Prasad Eye Institute, Hyderabad, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Matthew P Simunovic
- Save Sight Institute, University of Sydney, NSW, 2006, Australia; Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Vivek Pravin Dave
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, L V Prasad Eye Institute, Hyderabad, India.
| | - Patrick Staropoli
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, India.
| | - Harry Flynn
- Bascom Palmer Eye Institute, Miami, FL, USA.
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Astley RA, Mursalin MH, Coburn PS, Livingston ET, Nightengale JW, Bagaruka E, Hunt JJ, Callegan MC. Ocular Bacterial Infections: A Ten-Year Survey and Review of Causative Organisms Based on the Oklahoma Experience. Microorganisms 2023; 11:1802. [PMID: 37512974 PMCID: PMC10386592 DOI: 10.3390/microorganisms11071802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular infections can be medical emergencies that result in permanent visual impairment or blindness and loss of quality of life. Bacteria are a major cause of ocular infections. Effective treatment of ocular infections requires knowledge of which bacteria are the likely cause of the infection. This survey of ocular bacterial isolates and review of ocular pathogens is based on a survey of a collection of isolates banked over a ten-year span at the Dean McGee Eye Institute in Oklahoma. These findings illustrate the diversity of bacteria isolated from the eye, ranging from common species to rare and unique species. At all sampled sites, staphylococci were the predominant bacteria isolated. Pseudomonads were the most common Gram-negative bacterial isolate, except in vitreous, where Serratia was the most common Gram-negative bacterial isolate. Here, we discuss the range of ocular infections that these species have been documented to cause and treatment options for these infections. Although a highly diverse spectrum of species has been isolated from the eye, the majority of infections are caused by Gram-positive species, and in most infections, empiric treatments are effective.
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Affiliation(s)
- Roger A Astley
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Md Huzzatul Mursalin
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Phillip S Coburn
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Erin T Livingston
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - James W Nightengale
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Eddy Bagaruka
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Jonathan J Hunt
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Michelle C Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
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Soleimani M, Masoumi A, Tabatabaei SA, Zamani MH. Citrobacter keratitis: predisposing factors and clinical characteristics. J Ophthalmic Inflamm Infect 2023; 13:3. [PMID: 36720767 PMCID: PMC9889583 DOI: 10.1186/s12348-022-00322-1] [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: 04/12/2022] [Accepted: 12/11/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To report predisposing factors, clinical presentation, antibiotic sensitivity, and management of Citrobacter-caused infectious keratitis. METHODS We retrospectively reviewed the medical records of culture-proven cases of Citrobacter keratitis in a tertiary referral center for 8 years (from January 2012 to September 2020). Demographic data of the patients, predisposing factors, and presenting signs were extracted. RESULTS Eighteen cases of microbial keratitis due to Citrobacter spp. were identified. The median age of the patients was 66 years (range: 10-89, interquartile range : 59-81). Thirteen patients were male and 5 were female. Multiple predisposing factors were identified in all eyes, including ocular surface disease (n = 8), previous corneal surgery (n = 6), and history of ocular trauma (n = 6). Five patients were diabetic. Corrected distance visual acuity (CDVA) of patients was light perception (LP) in 8 patients, hand motion (HM) in 7, counting fingers (CF) at 1 m in 1, and CF at 2 m in 2 patients. Thirteen eyes exhibited hypopyon. An area of corneal thinning was observed in 7 eyes (38.9%). Endophthalmitis due to infectious keratitis developed in one patient. In vitro susceptibility testing confirmed high sensitivity to ceftazidime and aminoglycosides. Medical management consisted primarily of topical amikacin (20 mg/ml) combined with topical cefazoline (50 mg/ml) (72.2%). Surgical tectonic procedures were carried out in 7 eyes (38.9%). CONCLUSION Citrobacter spp. is a rare cause of bacterial keratitis.Previous keratoplasty and ocular surface problems are important risk factors. The prognosis is not good and surgical tectonic intervention is required in many cases to resolve the corneal infection.
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Affiliation(s)
- Mohammad Soleimani
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Ahmad Masoumi
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Seyed Ali Tabatabaei
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
| | - Mohammad Hossein Zamani
- grid.411705.60000 0001 0166 0922Ocular Trauma and Emergency Department, Tehran University of Medical Sciences, 1336616351 Tehran, Iran
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Wong DHT, Liu CCH, Tong JMK, Luk WK, Li KKW. CITROBACTER ENDOGENOUS ENDOPHTHALMITIS: A CASE REPORT AND REVIEW OF THE LITERATURE. Retin Cases Brief Rep 2020; 14:187-191. [PMID: 29155695 DOI: 10.1097/icb.0000000000000667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE We present a case of endogenous endophthalmitis because of an unusual bacterium, Citrobacter koseri. PATIENT A 57-year-old woman without previous history of eye surgery or trauma presented with diabetic ketoacidosis and a painful right eye with the reduction of vision. C. koseri was identified in blood culture; thus, a diagnosis of right eye endogenous endophthalmitis was made. Intravenous and intravitreal antibiotics were both started, and vitreous culture further confirmed C. koseri as the causative organism. Computed tomography of the abdomen and pelvis revealed a right C-shaped perinephric abscess, which was drained under ultrasound guidance. RESULTS Because of rapid progression to corneal melting, evisceration was performed. CONCLUSION Cases of endogenous endophthalmitis caused by Citrobacter are very limited, and a review of all published cases in the English literature and the present case revealed that endogenous Citrobacter endophthalmitis arose almost entirely from Citrobacter renal infection. Early recognition and drainage of renal abscess may lower the chance of uncontrolled infection and endogenous spread to the eyes. Despite prompt and intensive treatment, the clinical outcome of Citrobacter endogenous endophthalmitis seems to be poor.
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Affiliation(s)
- Daniel H T Wong
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Candice C H Liu
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Justin M K Tong
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Wei-Kwang Luk
- Pathology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong SAR, China
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
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Ratra D, Saurabh K, Das D, Nachiappan K, Nagpal A, Rishi E, Bhende P, Sharma T, Gopal L. Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India. Asia Pac J Ophthalmol (Phila) 2015; 4:286-92. [PMID: 26181589 DOI: 10.1097/apo.0000000000000120] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. DESIGN This study is a retrospective, noncomparative case series. METHODS This study presents a retrospective analysis of records of patients with EE in a 10-year period. RESULTS A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. CONCLUSIONS This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.
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Affiliation(s)
- Dhanashree Ratra
- From the Bhagawan Mahavir Department of Vitreoretinal Diseases, Sankara Nethralaya Medical Research Foundation, Chennai, India
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Cong'En JH, Miah M, Sünkel-Laing B, Emmanuel J. Endogenous endophthalmitis caused by Citrobacter koseri originating from a renal abscess. BMJ Case Rep 2014; 2014:bcr-2014-204095. [PMID: 25096654 DOI: 10.1136/bcr-2014-204095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a rare case of endogenous endophthalmitis caused by Citrobacter koseri. A 69-year-old woman with a history of poorly controlled diabetes and a protracted urinary tract infection (UTI) presented with a painful swollen left eye. There was no history of eye surgery or trauma. Imaging revealed an abscess in the right kidney. Although endophthalmitis is very rare in healthy patient, it is more common in the immunocompromised. In this patient, several multiple system illnesses including poorly controlled diabetes appear to have worked synergistically to make endophthalmitis a realistic complication of an otherwise isolated and remote source of infection, in this case pyelonephritis. Endophthalmitis, in the absence of an obvious exogenous cause, should be investigated thoroughly to exclude metastatic microbial spread. In addition, chronic features of UTI in a patient with poorly controlled diabetes or who is otherwise immunosuppressed warrant the exclusion of an underlying renal abscess.
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Deveci A, Coban AY. Optimum management of Citrobacter koseri infection. Expert Rev Anti Infect Ther 2014; 12:1137-42. [DOI: 10.1586/14787210.2014.944505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Aydin Deveci
- Department of Infectious Disease and Clinical Microbiology, Medical School, Ondokuz Mayis University,
55139, Samsun, Turkey
| | - Ahmet Yilmaz Coban
- Department of Medical Microbiology, Medical School, Ondokuz Mayis University,
55139, Samsun, Turkey
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Endophthalmitis caused by Citrobacter species: a case series. Can J Ophthalmol 2013; 48:216-7. [PMID: 23769785 DOI: 10.1016/j.jcjo.2012.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 12/13/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the clinical profile and drug sensitivity patterns in Citrobacter endophthalmitis. DESIGN Retrospective interventional case series. METHODS Retrospective analysis of all the cases of Citrobacter endophthalmitis presenting to a tertiary referral ophthalmic centre in eastern India from January 2009 to December 2011 was done. RESULTS Five cases were included in the study. Of these 5, 1 was posttraumatic, 1 was of endogenous origin, and the rest were postoperative. Vitreous surgery was done for 3 cases, whereas 1 patient declined surgery. The endogenous case received only intravitreal antibiotics. All isolates were sensitive to ciprofloxacin. Only 1 of the 5 isolates was sensitive to ceftazidime. Only 1 eye achieved a final visual acuity of 20/60 and the rest became phthisical at final follow-up. CONCLUSIONS Citrobacter is a rare cause of endophthalmitis with poor outcome. Ciprofloxacin should be considered as the first line of treatment.
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Kang HM, Chung EJ. Late-onset Citrobacter koseri endophthalmitis with suture exposure after secondary intraocular lens implantation. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:285-8. [PMID: 21860579 PMCID: PMC3149143 DOI: 10.3341/kjo.2011.25.4.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 05/10/2010] [Indexed: 11/23/2022] Open
Abstract
A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Yonsei University Medical Center, Seoul, Korea
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Arevalo JF, Jap A, Chee SP, Zeballos DG. Endogenous endophthalmitis in the developing world. Int Ophthalmol Clin 2010; 50:173-87. [PMID: 20375870 DOI: 10.1097/iio.0b013e3181d26dfc] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Fernando Arevalo
- Clinica Oftalmologica Centro Caracas, Edif. Centro Caracas PH-1, Av. Panteon, Caracas, Venezuela
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12
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Current world literature. Curr Opin Ophthalmol 2009; 21:81-90. [PMID: 19996895 DOI: 10.1097/icu.0b013e3283350158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Current world literature. Curr Opin Ophthalmol 2009; 20:333-41. [PMID: 19535964 DOI: 10.1097/icu.0b013e32832e478f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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