Outbreak Of Endophthalmitis Research Articles

Acute endophthalmitis outbreak after cataract surgery

Purpose: To evaluate the source of organisms causing an epidemic of postoperative endophthalmitis and to emphasize the importance of prompt intervention with an early diagnosis.Setting: S.B. Ankara Hospital Eye Department, Ankara, Turkey.Methods: Thirteen patients who had surgery on the same day and developed acute postoperative endophthalmitis were evaluated. Clinical patterns were observed and intraocular cultures and stains performed in 10 eyes. Broad-spectrum intravitreal antibiotics were injected on an empirical basis.Results: Intravitreal cultures showed Pseudomonas aeruginosa in four cases and coaguIase-negative staphylococci in three cases; three cases were culture negative. P. aeruginosa were also isolated from irrigation solutions used on the same day. Two patients with P. aeruginosa had a visual acuity of 20/200 and 20/300, respectively.Conclusion: The different culture results were probably related to the amount of inoculation, individual risk factors, and the subconjunctival antibiotic injection given at the end of surgery. That one patient with P. aeruginosa endophthalmitis retained a visual acuity of 20/200 shows the importance of rapid intravitreal antibiotic treatment.

Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir.

During October and November 1993, four patients contracted Acremonium kiliense endophthalmitis at one ambulatory surgical center. We hypothesized that the source was environmental and conducted a matched case-control study, environmental evaluation, and observational studies. Case and control patients were similar in clinical characteristics. However, case patients all had surgery on the first operative day of the week or had surgery significantly sooner after the operating room opened than did controls (a median of 46 vs. 150 minutes afterward; P = .03). An environmental review revealed the ventilation system was switched on 5-30 minutes before procedures began on the first operative day of the week, and air was filtered before but not after humidification. Cultures of the humidifier water in the ventilation system yielded A. kiliense phenotypically identical to isolates from case patients. Our data suggest that switching on the ventilation system each week aerosolized a reservoir of A. kiliense and caused infection of patients. We believe this is the first reported outbreak of fungal endophthalmitis traced to an environmental source, and it underscores the importance of utilizing established hospital infection control practices in the outpatient setting.

Epidemiology of an outbreak of Candida endophthalmitis in heroin addicts: identification of possible source of infection by biotyping.

Biotyping was employed to investigate possible sources of Candida endophthalmitis in heroin addicts. Isolates of Candida albicans recovered from patients and from injection paraphernalia, including lemon juice diluent from lemon-shaped plastic containers, were biotyped. The predominant biotypes were 153, 15 3/7. Similar biotypes were recovered from lemon, mouthwash, mouth swab and vitreous samples.

Outbreak of bacterial endophthalmitis after cataract surgery and lens implantation: Lack of direct evidence for exogenous contributing factors

Bacterial endophthalmitis is a rare but devastating disease. The risk of infection after intraocular surgery has declined from about 10% at the turn of the century to about 1% in the 1950s and about 0.35% at present.’ Most reports, however, stress that infection incidence rates are not easily established and not easily interpretable,‘*’ and actual rates may be higher. Intraocular prosthetic lens implantation has become an increasingly popular procedure in the therapy of patients with cataracts. This national trend is reflected by the 100% per year increase of this procedure at our institution in each of the past 3 years. Before May 1984, we had documented two hospital-acquired eye infections after cataract removal and lens implantation in 707 patients (0.3%). The Department of Ophthalmology called our attention to two cases of postimplant endophthalmitis in June 1984. Intensive hospital and postdischarge surveillance identified a total of six cases of bacterial endophthalmitis in 456 patients (1.3%) during the next 5 months. This report summarizes our epidemiologic investigations and steps taken to control this outbreak.

Outcome of cluster endophthalmitis in western plain region of Nepal

Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for 7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis.