Unusual microbiological presentations in polymicrobial post-operative endophthalmitis and their clinical correlations

Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.

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Section: Discussionmentioning

confidence: 99%

“…34 S. paucimobilis has been isolated in ophthalmic surgery. 35 In a recent study, K. kristinae was isolated from the postoperative wound of a patient in a tertiary hospital in Sierra Leone. 18 Antibiotic resistance is a global health problem, as it continues to increase at unparallel scale.…”

Section: Discussionmentioning

confidence: 99%

The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study

Lakoh

Russell

et al. 2022

Therapeutic Advances in Infection

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“…This case responded well to vitrectomy and antibiotics with no further recurrence [ 12 ]. Likewise, Mitra et al reported a case who developed delayed endophthalmitis 1 month after his surgery, who saw complete resolution of his disease with vitrectomy and an intense antibiotics regimen [ 13 ]. Another case has been reported in China, although, the findings remain untranslated [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent post-operative endophthalmitis caused by Sphingomonas paucimobilis despite vitrectomy – a case and review of the literature

Tran

Hayes

Franzco

et al. 2023

J Ophthal Inflamm Infect

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Over the past 20 years, scattered reports have emerged about a low virulence, gram negative bacillus, Sphingomonas paucimobilis, causing unpredictable clinical presentations of endophthalmitis. Previous reports have characterised the organism as being resistant to aggressive treatment and prone to recurrence up to several months later, with few warning signs of any residual infection. We report a case of a 75 year-old male who returned 10 days after a left eye cataract surgery with an atypical, indolent endophthalmitis. He was treated with broad-spectrum intravitreal antibiotics and vitrectomy, and despite initial improvement, the patient suffered a recurrence after 2 weeks, necessitating successive rounds of intravitreal antibiotics. While our patient was able to achieve an excellent final visual acuity of 6/9, there are several cases in the literature reporting similar cases with much worse visual outcomes. Further research is required to elucidate early warning signs that may indicate a recurrence of S. paucimobilis infection, and the underlying mechanism by which it is resistant to standard endophthalmitis therapy. Alongside this case, we review and summarise the literature on postoperative endophthalmitis involving this organism.

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“…In humans, this microorganism is known as an opportunistic pathogen that causes pulmonary infection associated with cystic fibrosis [2]. Recently, the reports related to ocular infections have been gradually on the rise, especially regarding endophthalmitis after ocular surgeries [3][4][5][6], including intravitreous injection of anti-vascular endothelial cell growth factor agent [7]. B. cepacia has been reported to contaminate topical anesthetics and has also been detected in a cornea tissue bank for keratoplasty [8], as well as rigid gas permeable trial lenses and lens cases [9].…”

Section: Introductionmentioning

confidence: 99%

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

Miura¹,

Toshida²

2022

Cureus

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In this report, we present a case of Burkholderia cepacia (B. cepacia)-induced bilateral microbial keratitis in a patient who wore colored contact lenses (CLs) on both eyes. The patient was a 19-year-old woman who presented to our hospital with pain, discharge, and photophobia affecting both eyes while she was wearing colored cosmetic CLs. There were corneal ulcers in both of her eyes without refractive correction. Although impairment of vision was not detected at the first visit, both eyes showed neovascularization of the upper part of the cornea and had relatively well-demarcated corneal ulcers associated with corneal stromal opacity. Cultures of cornea grew B. cepacia in both eyes. She received antimicrobial agents to which this organism was sensitive, resulting in the healing of the corneal ulcers with scarring after approximately one month. Improper fitting of colored cosmetic CLs, contamination of lenses or solutions, and inadequate lens care can be risk factors for developing this condition.

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Unusual microbiological presentations in polymicrobial post-operative endophthalmitis and their clinical correlations

Abstract: Unusual combinations of organisms in post-operative endophthalmitis can introduce unique clinical characteristics and should specifically be considered in atypical clinical presentations, poor response to standard therapy and unusual recurrence patterns.

Cited by 3 publications

References 13 publications

The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study

The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study

Recurrent post-operative endophthalmitis caused by Sphingomonas paucimobilis despite vitrectomy – a case and review of the literature

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

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