Ten years after an outbreak of Fusarium endophthalmitis following cataract surgery

Alagöz, Neşe

doi:10.5935/0004-2749.20200106

Cited by 2 publications

(2 citation statements)

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“…Similarly, 47 cases of infection caused by intraocular dye and contaminated medication from the same manufacturer were reported in the United States (13). In addition, retrospective studies analyzing the causes, treatments, and prognoses on the basis of hospital medical records over several years and a report on treatment results in 7 individual cases have been published (5,14,15). In 2 previous outbreaks involving contaminated medical products in the United States, epidemiologic investigations of the reported medical institutions identified intraocular dye used in retinal surgery that was contaminated with F. incarmatum-equiseti (13) and prefilled saline flush syringes contaminated with Burkholderia cepacia complex because of an inappropriate sterilization process (16).…”

Section: Discussionmentioning

confidence: 99%

Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020

Yoon¹,

Kim²,

Bahk³

et al. 2022

Emerg. Infect. Dis.

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A lthough the number of cataract surgery procedures is increasing globally because of an aging population, the incidence of postoperative endophthalmitis is declining because hygiene and surgical environments have improved (1,2). Postsurgical fungal endophthalmitis is difficult to diagnose because symptoms, such as decreased vision and eye pain, are nonspecific (3). Most cases of postoperative endophthalmitis are caused by bacteria, and ≈75% occur within 1 week after surgery (4). Because the symptoms of bacterial and fungal endophthalmitis are similar, intraocular fluid culture is crucial for an accurate diagnosis (5). Preventing serious complications such as vision loss requires immediate diagnosis, vitrectomy, and long-term antifungal therapy (6,7).Postoperative endophthalmitis rarely occurs in South Korea; only ≈63 cases are reported per 100,000 cataract surgeries (8). However, the Korean Ophthalmological Society (KOS) recognized a sudden increase in endophthalmitis cases after cataract surgeries during September-November 2020, when ≈100 cases were reported nationwide. Cases included clinical findings of fungal endophthalmitis, including isolation of Fusarium species. Thus, in November 2020, KOS informed the Korea Disease Control Agency (KDCA), which promptly collaborated with the Korea Ministry of Food and Drug Safety (KMFDS) to investigate the unusual increase in fungal endophthalmitis, identify the cause, and recommend control measures.During the epidemiologic investigation, KMFDS collected commercially available samples of ocular viscoelastic devices (OVDs) from 6 manufacturers to conduct quality testing. OVDs are substances injected under the cornea to maintain the shape of the eye during cataract surgery and remain in the eyeball until the last step of surgery, when the OVD is removed. Thus, contaminated OVDs can cause intraocular infection. We describe an outbreak of fungal endophthalmitis after cataract surgery and confirmation of the cause through epidemiologic and microbiologic investigations. Materials and Methods Outbreak DeterminationTo determine whether the cases reported by KOS could be classified as an outbreak, KDCA analyzed data from Health Insurance Review and Assessment

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Section: Discussionmentioning

confidence: 99%

Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020

Yoon¹,

Kim²,

Bahk³

et al. 2022

Emerg. Infect. Dis.

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“…The removal of the intraocular lens resulted in clinical improvement in all cases. In a hospital in Turkey, eight cases of F. solani species complex (FSSC) endophthalmitis occurred following cataract surgery performed on the same day [270,271]. No environmental source was identified, although contamination of the lens irrigating solution was suspected.…”

Section: Fusarium Speciesmentioning

confidence: 99%

Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management

Douglas,

Stewart,

Halliday

et al. 2023

JoF

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Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.

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Ten years after an outbreak of Fusarium endophthalmitis following cataract surgery

Cited by 2 publications

References 0 publications

Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020

Fungal Endophthalmitis Outbreak after Cataract Surgery, South Korea, 2020

Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management

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