Staphylococcus Lugdunensis Endophthalmitis After Intravitreal Injection

Abstract

This case series demonstrates that S. lugdunensis endophthalmitis can follow an aggressive course atypical for coagulase-negative organisms. Accurate identification of S. lugdunensis is important for management and prognosis. However, identification of S. lugdunensis is confounded by potential false-positive coagulase tests and the lack of routine speciation by microbiology laboratories.

Staphylococcus lugdunensis endophthalmitis following dexamethasone intravitreal implant

“…with aggressive course of disease leading to poor visual outcomes ranging from 6/30 to hand movements. [5] S. aureus and S. lugdunensis have similar clinical infection course and patients appear to have greater hypopyon height as compared to other coagulase-negative Staphylococcus endophthalmitis cases. [6] Our endophthalmitis case had similar presentation to the above description with insidious onset and rapid growing hypopyon once the endophthalmitis was in full bloom [Fig.…”

Acute-onset endophthalmitis caused by Staphylococcus lugdunensis

“…Murad-Kejbou and colleagues reported three cases of acute-onset endophthalmitis associated with intravitreal injections for age-related macular degeneration with poor final visual outcomes. 4 These poor visual outcomes may partially be explained by pre-existing ocular disease including advanced glaucoma and advanced macular degeneration limiting the original visual potential of the eye. In a report of five patients with S. lugdunensis associated acute-onset bacterial endophthalmitis after cataract surgery, Chiquet et al described two patients with good vision after successful medical treatment of endophthalmitis, but also several patients with poor visual outcomes after surgical treatment with pars plana vitrectomy which resulted in retinal detachment.…”

“… 3 Several investigations of patients with endophthalmitis caused by S. lugdunensis have been reported following cataract surgery and intravitreal injections. 4 , 5 , 6 The current series characterizes the clinical presentation, antibiotic sensitivities, and treatment outcomes of all patients treated for acute-onset endophthalmitis caused by S. lugdunensis.…”

Infection Prevention: The Surgical Care Continuum

“…Injecting medication into sterile organ spaces including the eye (intravitreal), spine, and joints is another type of a nonsurgical invasive procedure after which an infection could be catastrophic for the patient 40‐42 . Infection prevention priorities in these procedures include use of appropriate PPE by the provider, appropriate skin prep (dual agent), and sterile disposable needles and medication vials used for one patient, one time 43 …”