Neonatal Endogenous Endophthalmitis: A Report of Six Cases

Abstract

Endogenous endophthalmitis is a rare but potentially blinding complication of neonatal sepsis. Early diagnosis and aggressive treatment are essential to avoid vision loss. Therapeutic options include systemic and intravitreal antibiotics, as well as vitrectomy in selected cases. We report a series of 6 premature very low birth weight neonates who developed endogenous endophthalmitis in our NICU over the past 3 years. Endophthalmitis was part of early-onset sepsis in 2 newborns, both of whom died, and late-onset sepsis in 4 newborns, of which 1 infant died. None of the neonates had any history of previous trauma or intervention to the eye. Maternal screening for congenital infections, including HIV, was negative in all. Causative organisms included Klebsiella pneumoniae (2 cases), Pseudomonas aeruginosa (2 cases), Methicillin-resistant Staphylococcus aureus (1 case), and Candida albicans (1 case). All bacterial isolates showed resistance to first-line antibiotics. Of the 3 survivors, 2 infants had normal vision in the affected eye, and 1 developed phthisis bulbi after corneal perforation and required enucleation. This report draws attention to the emergence of endophthalmitis as a complication of neonatal sepsis in places where, although survival of very low birth weight newborns has increased significantly due to improved care, the burden of infection continues to be high. We emphasize the importance of daily examination of eyes as a part of routine clinical care in septic newborns for early diagnosis of endophthalmitis and prompt intervention in consultation with an ophthalmologist to optimize the outcome.

Clinical profile and outcomes of pediatric endogenous endophthalmitis: A report of 11 cases from South India

“…It can also occur as a rare complication of neonatal sepsis. In a particular series in India from a tertiary hospital for every 1000 live births, 1 case of endophthalmitis was seen[4]. The incidence of neonatal endophthalmitis from the United States is about 4.42 cases per 100000 live births[5].…”

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave

“…La prematuridad, aunque menos conocido, es también un factor de riesgo, tanto por el bajo peso al nacer (< 1.500 g) 13 como por la probabilidad de desarrollar retinopatía del prematuro 14 , a su vez factor predisponente por favorecer la isquemia responsable de la neovascularización de los vasos, de modo similar al que acontece en la retinopatía diabética 15 .…”

Methicillin-Resistant Staphylococcus aureus and the Eye: Current Concepts and Management Strategies

“…Reports of MRSA ophthalmic infections are numerous in the literature. They are more commonly seen in patients in neonatal ICUs [61][62][63], in post-ocular surgical patients [64][65][66][67][68][69][70][71][72][73][74][75], among healthcare workers [76,77] after corneal refractive surgery [77][78][79][80][81][82][83][84], in hospitalized pediatric patients [85], and in patients with chronic medical disease, immuno-suppression, or immunodeficiency [70,86].…”

“…The MRSA prevalence rate increased 12.1 % during the 5-year period (from 29.5 % in 2000 to 41.6 % in 2005) [114]. Amato et al [93] Small case series (based on microbiology results or drug trials) Shanmuganathan et al [123] Rutar et al [91] Adebayo et al [124] Lichtinger et al [95] Sotonzono et al [118] Case reports site-specific Lacrimal system Kotlus et al [90] Rutar [107] Kubal and Garibaldi [105] Chandravanshi et al [106] Gould et al [125] Conjunctiva Tarabishy et al [85] Cimolai [61] Ikeda et al [119] Mantadakis et al [113] Cellulitis Mehra et al [98] Charalampidou et al [99] Juthani et al [101] Vaska et al [104] Soon [100] Mathias et al [102] Endophthalmitis Deramo et al [96] Major et al [97] Ursea et al [126] Ho et al [86] Basu et al [62] Keratitis Sotozono et al [67] Lee et al [69] Chou et al [65] Post-surgical case reports Cataract surgery Cosar et al [75] Tang et al [70] Retinal surgery Oshima et al [68] Feiz and Redline [72] Rich et al [74] Pterygium surgery Lee et al [73] Curr…”