Abstract
PurposeTo report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomesMethodsThis was a hospital-based, retrospective case study with 13 consecutive patients who had man- ual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environ- mental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relation- ship between bacterial isolates recovered from study patients and contaminated surveillance samples.ResultsPseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients.ConclusionPositive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.
Highlights
12.5 million people are blind in India and cataract is the main contributor to this striking number accounting for 50–80% of cases.[1]
A 0.1 mL anterior chamber sample was collected from 10 patients using a 30-gauge needle and syringe before the administration of intravitreal antibiotics, while vitreous samples were collected from three patients at the time of pars plana vitrectomy and sent to the microbiology laboratory
The current study describes an outbreak of cataract surgery-related MDR Pseudomonas aeruginosa endophthalmitis caused by contaminated trypan blue ophthalmic solution
Summary
12.5 million people are blind in India and cataract is the main contributor to this striking number accounting for 50–80% of cases.[1]. With the improvement in preoperative prophylactic measures, sterilization protocols, surgical techniques, and good postoperative care, the infection rate after cataract surgery has decreased. Postoperative endophthalmitis is a catastrophic complication of intraocular surgery mainly associated with cataract extraction and intraocular lens (IOL) implantation, with an incidence of 0.08 to 1%.[3] The most common causative organisms are gram-positive coagulase negative bacteria; gram-negative organisms have been isolated from 6% to 29% of cases in larger reported series.[4] Despite the low prevalence of gramnegative organisms, a more vigorous management approach including early vitrectomy is required, as these organisms are highly virulent
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