Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery

Abstract

Background Postoperative endophthalmitis is a rare but dreaded complication of intraocular surgery and often results in severe visual impairment or blindness. The present study describes the clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery. Methods Among 290 patients who underwent uneventful phacoemulsification cataract surgery at one outpatient clinic between January 4th and 28th 2019, 6 cases developed Burkholderia contaminans endophthalmitis. Clinical data were collected by retrospective review of patient records. Microbiological samples from vitreous aspirates, intraocular lenses (IOL) and lens capsules were cultured, and recA and draft whole genome sequences analysed. Results The recA sequences of all Burkholderia contaminans isolates and the allelic profile of the isolates were identical. All cases had a similar clinical presentation with rapid development of endophthalmitis symptoms with variable time to onset. The mean time to admission was 34 days (12–112 days). All cases had a seemingly favourable response to intravitreal antibiotics. However, acute recurrences occurred after long time periods (12–71 days). The cases experienced between 0 and 3 recurrences. Due to persistent infection, the cases received between 5 and 15 treatments (mean 7.8) including IOL and lens capsule explantation in 5 of 6 cases. Burkholderia contaminans was detected in all explanted lens capsules. The final corrected distance visual acuity (CDVA, Snellen chart) was between 0.8 and 1.2 and all cases had final CDVA ≥0.8. Conclusions A persistent and intensive treatment approach including total lens capsule and IOL explantation is recommended for Burkholderia contaminans endophthalmitis following cataract surgery and may lead to a favourable visual result.

Burkholderia Postoperative Endophthalmitis and an Outbreak Including Bilateral Simultaneous Postoperative Endophthalmitis

“…Outcomes of the Narvik patients were compared to literature Bcc POE reports. describes the treatment of all patients at UNN, and we agree with that table except for the exact dates of POE diagnoses and their omission of the second eye of case 3 [8].…”

“…Previous studies have found Bcc to have low susceptibility to the commonly used IC antibiotics, including cefuroxime (administered here -ESCRS protocol) and vancomycin, but is usually sensitive to ciprofloxacin [20,22,24,29]. Culture results in this series showed resistance to cefuroxime, with sensitivity to ceftazidime, ciprofloxacin, gentamicin and piperacillin/tazobactam, the last of which is generally effective against Bcc [8]. All patients recovered final corrected distance visual acuity of 20/25 or better, likely because Lind., et al performed a "persistent and intensive treatment approach" with IOL explantation and total lens capsule removal (for all except both eyes of case 3) [8].…”

“…Thorough assessment of the surgical facility was performed. All details related to patients, surgeries, and treatments were confirmed with the operating surgeon (author JK) and from a recent publication by Lind., et al describing their management and outcome after referral to the University Hospital of Northern Norway (UNN-Tromsø) [8]. PubMed and Google were searched for reports on Bcc infections and Bcc-induced POE.…”

“…All patients recovered final corrected distance visual acuity of 20/25 or better, likely because Lind., et al performed a "persistent and intensive treatment approach" with IOL explantation and total lens capsule removal (for all except both eyes of case 3) [8]. Nevertheless, all cases, except case #3, required multiple re-administration of antibiotics with vitrectomies, perhaps due the ability of B. contaminans to colonize the IOL surface and lens capsule with VBNC biofilm formation [8].…”

“…The gram-negative, Burkholderia cepacia complex (Bcc), specifically Burkholderia contaminans, caused 5 unilateral and 1 bilateral simultaneous postoperative endophthalmitis (BSPOE) after unilateral (UCS) and immediately sequential bilateral cataract surgeries (ISBCS) in northern (arctic) Norway in January 2019 [8].…”