An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification

Abstract

Purpose: To describe an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery. Clinical findings, treatment and outcome are discussed. Methods: Clinical charts review of forty-five patients treated for endophthalmi tis in a two-day period. The patients underwent primary vitrectomy, anterior chamber irrigation and intravitreous antibiotic injection. Cultures from vitreous and anterior chamber samples were performed in all patients. Results: Forty-five patients (twenty-three men and twenty-two women) were identified. The average age was 71.2 years (range, 56-83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5.5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), and light perception in thirty patients (68%). Pseudomo nas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Overall, one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent evisceration or enucleation in a three-month follow-up period. Conclusion:Even with all the safety that cataract surgery has achieved, today, en dophthalmitis remains a risk and a fearful complication of this procedure. In the present study, it was impossible to identify the source of the outbreak.

Endophthalmitis Caused by Pseudomonas Aeruginosa

“…12 This may explain why the rate of globe loss is lower in specific series focusing on only postcataract extraction outbreaks of P. aeruginosa endophthalmitis, ranging from 0% to 50%. 7,9,10 Such outbreaks have occurred secondary to contaminated ophthalmic solutions, such as trypan blue, contamination of phacoemulsifier internal fluid, contamination of the intraocular lens solution, and contamination of the phacoprobe. 6,9,[21][22][23] This reflects the ability of P. aeruginosa to survive over long periods in aqueous environments.…”

“…[3][4][5] There have also been several reported large outbreaks of postcataract surgery P. aeruginosa endophthalmitis secondary to contamination. [6][7][8][9][10] In previous reports, the most common clinical settings for P. aeruginosa endophthalmitis included infectious keratitis, acute-onset postcataract surgery, postpenetrating keratoplasty, and endogenous source. 11,12 In other clinical settings, P. aeruginosa has demonstrated increasing levels of resistance to previously effective broad-spectrum antibiotics, including aminoglycosides, cephalosporins, extended-spectrum penicillins, and carbapenems.…”

Neste fascículo dos ABO

“…A publication with the highest incidence of infectious endophthalmitis by Pseudomonas aeruginosa in the world (1) revealed that 20% of the 45 eyes that underwent vitrectomy presented visual acuity of at least 20/200. Although the source of the outbreak has not been identified, all patients had undergone cataract surgery by phacoemulsification in a single institution in a given period of two days.…”

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In this issue of the ABO

Neste fascículo dos ABO

Wallace chamonSeveral original and unpublished articles of great clinical importance are published in this issue of the ABO, showing that, increasingly, the authors recognize the quality and comprehensiveness of our journal.A publication with the highest incidence of infectious endophthalmitis by Pseudomonas aeruginosa in the world (1) revealed that 20% of the 45 eyes that underwent vitrectomy presented visual acuity of at least 20/200. Although the source of the outbreak has not been identified, all patients had undergone cataract surgery by phacoemulsification in a single institution in a given period of two days.

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An outbreak of post cataract Pseudomonas aeruginosa acute endophthalmitis in Egypt

“…The causative organisms represent bacteria from patient's own periocular flora, of which the most common is Staphylococcus epidermidis: 60 to 80% of cases (Durand 2017;Kresloff et al 1998;Pijl et al 2010). However, outbreaks of post-cataract surgery endophthalmitis are often due to infection with Gram-negative organisms including Pseudomonas aeruginosa (Guerra et al 2012).…”