scholarly journals Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110553
Author(s):  
Kasra Cheraqpour ◽  
Aliasghar Ahmadraji ◽  
Seyed Ali Tabatabaei ◽  
Bahram Bohrani Sefidan ◽  
Mohammad Soleimani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Visual Acuity ◽  
Cataract Surgery ◽  
Clinical Findings ◽  
Postoperative Endophthalmitis ◽  
Causative Pathogen ◽  
Light Perception ◽  
Strict Adherence ◽  
Gram Negative ◽  
Source Of Infection

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.

scholarly journals Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution

2019 ◽  
Author(s):  
Pritam Bawankar ◽  
Harsha Bhattacharjee ◽  
Manabjyoti Barman ◽  
Ronel Soibam ◽  
Hemalata Deka ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cataract Surgery ◽  
Genomic Dna ◽  
Trypan Blue ◽  
Dna Typing ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Postoperative Endophthalmitis ◽  
Retrospective Case ◽  
Multiple Drugs

Purpose: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes. Methods: This was a hospital-based, retrospective case study with 13 consecutive patients who had manual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environmental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relationship between bacterial isolates recovered from study patients and contaminated surveillance samples. Results: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients. Conclusion: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.

scholarly journals Detection of prevalence of metallo-beta lactamases in clinical isolates of imipenem resistant Pseudomonas aeruginosa from neonatal septicaemia cases in a tertiary hospital in Odisha, India

2017 ◽  
Vol 5 (1) ◽  
pp. 61 ◽  
Author(s):  
Surya Narayan Mishra ◽  
Seba Ranjan Biswal ◽  
Basanta Kumar Behera ◽  
Dipti Pattnaik
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Isolates ◽  
Beta Lactamase ◽  
Strict Adherence ◽  
Neonatal Septicemia ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Pseudomonas Spp ◽  
Neonatal Septicaemia ◽  
Synergy Test

Background: Pseudomonas aeruginosa is a clinically troublesome gram-negative pathogen that causes both opportunistic infections and nosocomial outbreaks. Metallo beta lactamase have recently emerged as a worrisome resistance mechanism. Carbapenems had been the drug of choice for the infections caused by most penicillin- or cephalosporin-resistant gram-negative bacteria due to its broad-spectrum activity and stability to hydrolysis by most beta-lactamases. This does not hold good anymore due to rapid uprise of MBL producing strains. The current research covered 163 hospitalized cases of neonatal septicaemia from which Pseudomonas aeruginosa is isolated in the Paediatric Department of KIMS, Bhubaneswar. The study aimed at detecting the prevalence of metallo-beta lactamases in clinical isolates of imipenem resistant Pseudomonas aeruginosa from neonatal septicemia cases and to establish the antibiogram of Imipenem-resistant P. aeruginosa these cases. Methods: Clinical samples obtained from suspected cases of neonatal septicemia were first cultured by conventional methods and then identification was done by VITEK-2 instrument. Metallo beta lactamase (MBL) production was done by combined disc synergy test (CDST) using imipenem and EDTA (CDST-IPM) and double disc synergy test (DDST) using IPM and EDTA (DDST-IPM). Results: Among 1510 processed clinical specimens from cases of neonatal septicaemia; 637 (42.18%) showed positive growth of various clinically significant pathogens. Out of them in 163 (25.58%) cases Pseudomonas spp. was isolated. Of these, a total of 95 (58.28%) Pseudomonas spp. was found resistant to imipenem. All imipenem-resistant Pseudomonas isolates were positive for MBL by CDST imipenem-EDTA (CDST-IPM) method, whereas 89 (93.68%) were positive by DDST-IPM method, respectively. Pseudomonas aeruginosa was mostly isolated from endotracheal tube aspirate (57.89%) followed by pus (56.41%). Out of the 95 cases of MBL-producing Pseudomonas; 46 (48.42%) isolates showed the maximum susceptibility to piperacillin-tazobactam combination. All MBL-producing Pseudomonas isolates were resistant to ceftriaxone.Conclusions: MBL-producing Pseudomonas is found to be highly prevalent in our hospital, which is one of the major causes of multidrug resistance and need regular surveillance and strict adherence to a robust antibiotic policy.

scholarly journals The Outcome of Vitrectomy in Acute Postoperative Endophthalmitis

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Sindy Boru Sembiring ◽  
Yulia Aziza ◽  
Gitalisa Andayani Adriono
Keyword(s):  
Visual Acuity ◽  
Clinical Diagnosis ◽  
Hand Movement ◽  
Case Series ◽  
Visual Outcome ◽  
Advanced Technology ◽  
Postoperative Endophthalmitis ◽  
Light Perception ◽  
Retrospective Case ◽  
Retrospective Case Series

Introduction: Twenty years ago, the results of Endophthalmitis Vitrectomy Study (EVS) were adapted worldwide as the standard management of endophthalmitis. The study suggested that there was no benefit of performing vitrectomy for acute postoperative endophthalmitis, unless for patients who presents with visual acuity of light perception. However, vitrectomy with advanced technology and technique has been changed rapidly in the last decades; therefore, we need to reconsider its role. We conducted a study and the purpose of our study was to describe the indications for vitrectomy and the outcomes in acute postoperative endophthalmitis at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Methods: Our study was a descriptive-retrospective case series. We reviewed clinical and microbiological records of all patients with clinical diagnosis of acute postoperative endophthalmitis who underwent vitrectomy in Cipto Mangunkusumo Hospital between 2007 and September 2015.  Presenting visual acuity, visual outcome and complications were described. Result: Our study was a descriptive-retrospective case series. We reviewed clinical and microbiological records of all patients with clinical diagnosis of acute postoperative endophthalmitis who underwent vitrectomy in Cipto Mangunkusumo Hospital between 2007 and September 2015.  Presenting visual acuity, visual outcome and complications were described. Conclusion: An eight-year experience has taught us that vitrectomy offers better treatment outcome in the group with visual acuity of hand movement than those who only had visual acuity of light perception.

scholarly journals Sphingomonas paucimobilis keratitis post cataract surgery: First case report from India

2019 ◽  
Vol 11 (1) ◽  
pp. 82-85 ◽  
Author(s):  
Manisha Acharya ◽  
Javed Hussain Farooqui ◽  
Hayden Spencer ◽  
Vinay Arora ◽  
Umang Mathur
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Medical Treatment ◽  
Cataract Surgery ◽  
Sphingomonas Paucimobilis ◽  
Gram Negative ◽  
Ophthalmic Manifestations ◽  
First Case ◽  
Surgery First ◽  
Patch Graft

Sphingomonas paucimobilis is a rare, aerobic Gram-negative soil bacillus rarely associated with intraocular infections. With only 3 cases of ophthalmic manifestations reported so far, we are presenting the fi rst case of S. Paucimobilis, causing keratitisafter cataract surgery, from India. The organism, which was resistant to initial medical treatment, eventually responded to a patch graft and the patient improved to a final visual acuity of 20/40.

Intravitreal Dexamethasone Implant for the Treatment of Postoperative Macular Edema

2016 ◽  
Vol 236 (4) ◽  
pp. 181-185 ◽  
Author(s):  
André Klamann ◽  
Katharina Böttcher ◽  
Philipp Ackermann ◽  
Gerd Geerling ◽  
Marc Schargus ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Clinical Findings ◽  
Results Of Treatment ◽  
Intravitreal Dexamethasone Implant ◽  
Pars Plana ◽  
The Mean ◽  
Intravitreal Dexamethasone ◽  
Evidence Based Guidelines

Introduction: Macular edema after cataract surgery (Irvine-Gass syndrome) or pars plana vitrectomy is a postoperative complication which can lead to permanent visual loss. Increased inflammatory substances, such as prostaglandins and cytokines, are discussed to be causative. Currently, there are no evidence-based guidelines for the treatment of postoperative macular edema. Intravitreal dexamethasone (DEX) could be effective by its anti-inflammatory effect. We examined the functional and morphological results of treatment with 0.7 mg intravitreal DEX implant (Ozurdex®). Methods: In an observational study, we analyzed visual acuity (logMAR), intraocular pressure (IOP), clinical findings, and the central macular thickness (CMT, optical coherence tomography [OCT] Spectralis®, Heidelberg Engineering, 30° macular scan, 19 scans) of 12 eyes before and 1 month after the last DEX implantation (off-label use, Ozurdex®, Allergan, Inc., Irvine, CA, USA) for macular edema after cataract surgery or vitrectomy. Re-implantation was performed when OCT showed new intraretinal fluid along with a decrease in the patient's visual acuity. The mean follow-up was 14.4 ± 10.6 months. Results: Twelve eyes of 12 patients (4 female, 8 male) with a mean age of 62.6 ± 11.9 years were treated with a mean of 2.5 ± 1.6 intravitreal DEX implant injections. Prior to injection, the visual acuity was 0.74 ± 0.34 logMAR and the CMT was 608 ± 129 µm. One month after the last injection (after a mean of 437 ± 322 days), the CMT normalized (300 ± 90 µm, p < 0.01) in all cases with a visual acuity of 0.49 ± 0.43 logMAR (p < 0.01). After 8.1 ± 5.3 months, recurring macular edema could be completely reduced by re-injection in 66% (8 patients). Four patients had no recurrence. Postinjection, the mean IOP was 17.4 ± 6.8 mm Hg. Postinjection, 7 patients required topical antiglaucomatous therapy. Conclusions: Treatment with an intravitreal DEX implant is an effective therapy for postoperative macular edema. Each injection leads to a complete resorption of the edema with a significant increase in visual acuity.

scholarly journals Community-acquired spontaneous acute meningitis by Pseudomonas in adult without risk factors

2021 ◽  
Vol 0 ◽  
pp. 1-3
Author(s):  
Sanjeev Kumar Singla ◽  
Rakendra Singh
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Organ Dysfunction ◽  
Case Reports ◽  
Rare Entity ◽  
Gram Negative ◽  
Source Of Infection ◽  
Acute Meningitis ◽  
Immunocompromised State

Community-acquired meningitis by Gram-negative bacilli (GNB) occurs commonly with preexisting conditions such as neurosurgery, neurosurgical devices, trauma, remote source of infection, organ dysfunction, and nosocomial and immunocompromised state, but rarely occurs without these risk factors. Few case reports with Escherichia coli and Pseudomonas aeruginosa that too have some risk factors have been described in literature till now. GNB meningitis is associated with high mortality. There is very little literature available for community-acquired P. aeruginosa meningitis to date in patient without risk factors. Community-acquired spontaneous P. aeruginosa meningitis with pyogenic ventriculitis in a patient without any risk factors in adults is a rare entity and is likely to under-recognized.

scholarly journals Postoperative Endophthalmitis Caused by Cutibacterium (Formerly Propionibacterium) Acnes: Case Series and Review

2021 ◽  
pp. 1-10
Author(s):  
Benjamin J. Fowler ◽  
Darlene Miller ◽  
Xiaohe Yan ◽  
Nicolas A. Yannuzzi ◽  
Harry W. Flynn Jr.
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Clinical Features ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Postoperative Endophthalmitis ◽  
Cutibacterium Acnes ◽  
Pars Plana ◽  
Microbiologic Diagnosis

We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by <i>Cutibacterium acnes (C. acnes)</i>, formerly known as <i>Propionibacterium acnes (P. acnes)</i>. This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven <i>C. acnes</i>from December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5–17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3–15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone (<i>n</i> = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (<i>n</i> = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics (<i>n</i> = 1). Follow-up treatments included IOL removal (<i>n</i> = 2), intravitreal antibiotics (<i>n</i> = 1), and topical antibiotics (<i>n</i> = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by <i>C. acnes</i>(<i>n</i> = 120) are listed<i>.</i> A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by <i>C. acnes</i>is characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.

Composition of the conjunctive microflora of the patients before outbulatory cataract surgery

2021 ◽  
pp. 42-44
Author(s):  
Y.V. Kudryavtseva ◽  
◽  
V.V. Podyninogina ◽  
L.V. Demakova ◽  
N.V. Ogorodova ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Surgical Treatment ◽  
Cataract Surgery ◽  
Wide Spectrum ◽  
Gram Negative ◽  
E Coli ◽  
Normal Microflora ◽  
Mucous Membranes ◽  
Propionibacterium Granulosum ◽  
Key Words Cataract Surgery

Purpose. Study of the composition of the conjunctival cavity in healthy patients before elective outpatient cataract surgery. Material and methods. The contents of the conjunctival cavity were examined in 30 patients who were admitted to the ophthalmological departments of the Kirov Clinical Ophthalmological Hospital for the surgical treatment of cataracts as planned. Results. The growth of microflora was detected in 100% of the studied patients when examining crops from the conjunctiva. Most of the identified microorganisms are representatives of the normal microflora of the human skin and mucous membranes. Conclusion. 1. The structure of the conjunctival microflora in patients before elective cataract surgery has a wide spectrum – aerobes (Staphilococcus aureus, Staphilococcus epidermidis) and anaerobes (Propionibacterium granulosum), gram-positive (Corinebacterium spp.) and gram-negative (Klebsiella sp., E. coli, Pseudomonas aeruginosa) microorganisms, as well as fungi of the genus Candida. 2. The most common representatives of the conjunctival cavity microflora are Candida fungi (72.4%), E. coli (65.5%), Enterococcus sp. (55.2%), Klebsiella sp. (55.2%), Strp.pyogenes (51.7%), which should be taken into account when prescribing antibacterial therapy in the pre – and postoperative period. Key words: cataract surgery, conjunctival microflora.

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