An Outbreak of Post-Cataract Surgery Endophthalmitis Caused by Pseudomonas aeruginosa

Pinna, Antonio; Usai, Donatella; Sechi, Leonardo Antonio; Zanetti, Stefania Anna Lucia; Jesudasan, Nelson; Thomas, Philip A.; Kaliamurthy, Jayaraman

doi:10.1016/j.ophtha.2009.06.004

Cited by 63 publications

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References 31 publications

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“…The largest Pseudomonas endophthalmitis outbreak post cataract surgery that we were able to find in the literature involved twenty eyes of twenty patients in a six-week period (14) . In the current study we had forty-five eyes of forty-five patients (twenty-six culture positive for Pseudomonas) in a two consecutive day period.…”

Section: Discussionmentioning

confidence: 99%

“…Endophthalmitis suspect cases cultures turn out to be positive in a range of 24% to 85% according to different studies (15) . Pseudomonas aeruginosa is one of the most common Gramne gative pathogens associated with nosocomial infections (14) . The epidemics seem to be related to contaminated intraocular irrigating solutions (6,7,9,12,14) .…”

Section: Discussionmentioning

confidence: 99%

“…Pseudomonas aeruginosa is one of the most common Gramne gative pathogens associated with nosocomial infections (14) . The epidemics seem to be related to contaminated intraocular irrigating solutions (6,7,9,12,14) . Pseudomonas was also identified in povidone-iodine solution (14) , at the fluid pathways of a phacoemulsifier (9) , water of autoclave (12) and air-conditioning system (14) .…”

Section: Discussionmentioning

confidence: 99%

“…The epidemics seem to be related to contaminated intraocular irrigating solutions (6,7,9,12,14) . Pseudomonas was also identified in povidone-iodine solution (14) , at the fluid pathways of a phacoemulsifier (9) , water of autoclave (12) and air-conditioning system (14) . Technics as high-resolution fluorescent amplified fragment length polymorphism ana lysis can identify the source of the outbreak to help preventing new ones (16) .…”

Section: Discussionmentioning

confidence: 99%

“…Outbreaks of postoperative P. aeruginosa endophthalmitis have been described in the literature (6)(7)(8)(9)(10)(11)(12)(13)(14) . The association with intrinsic contamination of ophthalmic solutions and contaminated instruments or equipment has been reported (6)(7)(8)(9)(10)(11)(12)(13) .…”

Section: Introductionmentioning

confidence: 99%

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

Guerra¹,

Freitas²,

Parcero³

et al. 2012

Arq. Bras. Oftalmol.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Guerra¹,

Freitas²,

Parcero³

et al. 2012

Arq. Bras. Oftalmol.

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Baseline Factors Predictive of Visual Prognosis in Acute Postoperative Bacterial Endophthalmitis in Patients Undergoing Cataract Surgery

et al. 2013

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; for the French Institutional Endophthalmitis Study Group IMPORTANCE Although rare, postoperative endophthalmitis in patients undergoing cataract surgery can lead to anatomical or functional loss of the eye. Therapeutic strategies such as antibiotic prophylaxis and microbiological diagnosis are more effective with a target patient population. New prospective data are needed to identify prognostic factors. OBJECTIVE To identify baseline factors of visual prognosis in patients with acute bacterial endophthalmitis after cataract surgery. DESIGN Prospective study of consecutive patients undergoing cataract surgery, enrolled from March 1, 2004, through December 31, 2005. We analyzed outcomes to determine the effect on the final visual outcome, defined as poor (visual acuity [VA] worse than 20/100) or good (VA 20/40 or better) using univariate and multivariate analysis. SETTING Four academic hospitals. PARTICIPANTS Ninety-nine consecutive patients with cataract. INTERVENTION Corneal phacoemulsification. MAIN OUTCOMES AND MEASURES Factors related to the cataract surgery (complications), initial clinical presentation, and microbiological diagnosis and the final VA. RESULTS The significant baseline factors (at presentation) for good visual outcome (45% of the series) were the winter season, absence of complications during cataract surgery, initial VA, microbiological investigations revealing no microorganism or a coagulase-negative Staphylococcus species (CNSP), and fundus visibility. Quantitative factors associated with a good clinical prognosis were shorter duration of cataract surgery, younger age, and a hypopyon no greater than 1.5 mm. Significant factors associated with poor visual outcome were infection of the right eye, initial VA, corneal edema, a hypopyon larger than 1.5 mm, detection of bacterial species other than a CNSP, and the absence of fundus visibility. Multiple logistic regression analysis showed that high bacterial virulence was the only independent factor (odds ratio, 14.0 [95% CI, 2.7-71.0]; P = .001) for poor visual outcome. On the other hand, low bacterial virulence (odds ratio, 0.2 [95% CI, 0.03-0.6]; P = .01) and the absence of complications during cataract surgery (0.1 [0.01-0.4]; P = .003) were independent factors for good VA. CONCLUSIONS AND RELEVANCE Most clinical outcome factors in acute postoperative endophthalmitis can be identified at presentation. The bacterial virulence level is the main factor predictive of the final visual prognosis.

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Antibiotic Resistance in Endophthalmitis Pathogens

2016

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An Outbreak of Post-Cataract Surgery Endophthalmitis Caused by Pseudomonas aeruginosa

Cited by 63 publications

References 31 publications

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

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

Baseline Factors Predictive of Visual Prognosis in Acute Postoperative Bacterial Endophthalmitis in Patients Undergoing Cataract Surgery

Antibiotic Resistance in Endophthalmitis Pathogens

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