Endophthalmitis Caused by Corynebacterium Species: Clinical Features, Antibiotic Susceptibility, and Treatment Outcomes

Abstract

Purpose To report the clinical features, antibiotic susceptibility profiles, treatment, and visual acuity (VA) outcomes of endophthalmitis caused by Corynebacterium species. Design Retrospective case series. Subjects Patients with endophthalmitis caused by Corynebacterium species. Methods Microbiology database records were retrospectively reviewed for all patients with endophthalmitis caused by Corynebacterium species from January 1, 1990 to December 31, 2012 at a large university referral center. The corresponding clinical records were then reviewed to evaluate the endophthalmitis clinical features and treatment outcomes. Main Outcome Measures presenting clinical features, visual acuity outcomes, and antibiotic susceptibility patterns. Results Of 10 patients identified, clinical settings included post-cataract surgery (n = 6), post-penetrating keratoplasty (n = 2), and post-trabeculectomy (n = 2). The mean time from surgical procedure to presentation with endophthalmitis was 6.8 months (range: 1 day to 28 months). All isolates were vancomycin susceptible. Presenting VA ranged from 7/200 to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 5) and pars plana vitrectomy with intravitreal antibiotic injection (n = 5). VA outcomes were ≥ 20/60 in 5 (50%) of 10 patients and ≤ 20/400 in 5 (50%) of 10 patients. Conclusions The most common clinical setting was post-cataract surgery. All isolates were susceptible to vancomycin. Despite prompt treatment with appropriate antibiotics, there were variable visual outcomes.

Current Evidence for Corynebacterium on the Ocular Surface

“…They attributed this resistance to overuse of fluoroquinolones eye drops in the ophthalmology field. C. macginleyi is an opportunistic pathogen that causes several ocular infections, including conjunctivitis [ 7 , 8 , 18 ], corneal keratitis [ 17 , 19 ], glaucoma bleb-related infections [ 30 , 31 ], and endophthalmitis [ 10 , 29 ]. C. macginleyi can also cause non-ocular infections, such as bladder catheter infections [ 33 ], intravenous catheter infections [ 34 , 35 ], and septicemia [ 36 ].…”

“…The susceptibility of Corynebacterium to drugs varies depending on the species, according to published reports [ 7 , 8 , 9 , 10 , 14 , 16 , 18 , 19 , 21 , 22 , 23 , 27 , 28 , 32 , 53 , 54 , 57 , 58 , 59 , 60 ]. In the ophthalmology field, large clinical cohorts of Corynebacterium on the ocular surface have not yet been sufficiently studied.…”

“…These various commensal bacteria aid in preventing ocular surface from invasion by foreign organisms [ 6 ]. However, in immunocompromised patients, many recent reports have demonstrated that Corynebacterium species can be potentially pathogenic when present on the ocular surface [ 7 , 8 , 9 , 10 ], as this infection has been associated with cases of endocarditis of the aortic and mitral valves [ 11 ], granulomatous mastitis [ 12 ], and pelvic osteomyelitis [ 13 ]. Many reports have been based on the case series [ 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Post-intravitreal injection endophthalmitis secondary to Turicella otitidis: a case report

“…Turicella otitidis classically shows good susceptibility to ß-lactams, vancomycin and fluoroquinolones [11,13]. Endophthalmitis due to Corynebacterium species in general has been shown to be susceptible to intravitreal vancomycin [6]. In this report, post-injection endophthalmitis secondary to Turicella otitidis appeared to be indolent in nature with a rapid response to empiric intravitreal vancomycin and ceftazidime.…”

“…Poorer clinical outcomes have been reported in post-anti-VEGF endophthalmitis associated with other species, particularly in Streptococcus species. Corynebacterium, a genus of gram positive bacilli or coccobacilli, is a rare cause of post-procedural endophthalmitis [5][6][7]. Corynebacterium was found in only about 1% of the Endophthalmitis Vitrectomy Study culture positive endophthalmitis cases [8] and has only rarely been reported after anti-VEGF injection [2].…”