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

Caroline Lind,Nina K Angelsen,Eliza Depoorter,Einar A Krefting,Karina Olsen,Peter Vandamme,Kirsten Gravningen,Kristian Fossen,Geir Bertelsen

doi:10.1186/s12348-021-00242-6

Abstract

BackgroundPostoperative 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.MethodsAmong 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.ResultsThe 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.ConclusionsA 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.

Highlights

Postoperative endophthalmitis is a rare but dreaded complication of intraocular surgery and often results in severe visual impairment or blindness
B. contaminans endophthalmitis was confirmed in six cases among 290 patients (2.1%) who underwent cataract surgery in a private outpatient clinic between January 4th to 28th 2019
In the present study, we report the clinical course, treatment and visual outcome of a B. contaminans endophthalmitis outbreak following cataract surgery treated with repeated intravitreal antibiotic injections, pars plana vitrectomy (PPV), and intraocular lenses (IOL) and lens capsule removal, resulting in a good visual outcome

Summary

Introduction

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. Due to improved surgical techniques and use of prophylactic intracameral antibiotics, the incidence of postoperative endophthalmitis following cataract surgery has decreased the last decades [1,2,3]. Endophthalmitis following cataract surgery is most commonly caused by Gram-positive bacteria, e.g. Staphylococcus epidermidis, originating from the patient’s skin flora [4]. BCC is predominantly associated with chronic pulmonary infections in patients with cystic fibrosis, but may cause infections in immunocompromised patients and patients with chronic granulomatous diseases [5]. BCC bacteria and in particular B. contaminans are commonly associated with contamination of pharmaceutical products such as nasal sprays, ultrasound gel, hand sanitizers, mouthwash and nebulization solutions [8, 9]

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