Stenotrophomonas maltophilia Induced Post-Cataract-Surgery Endophthalmitis: Outbreak Investigation and Clinical Courses of 26 Patients
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Stenotrophomonas maltophilia, a microorganism which colonizes plastic material, is a rare causative agent of iatrogenic endophthalmitis.
Patients and Methods:
A cluster of 26 cases of acute post-cataract-surgery endophthalmitis (PE) was identified. An outbreak investigation was performed. Information was abstracted from patients’ charts and questionnaires sent to patients and their general practitioners. Vision was examined before, during, as well as one and six months after acute PE. Bacterial isolates were subjected to molecular typing.
All patients initially received empiric systemic antibiotic treatment. The source of the infections was identified to be the rinsing solution used during cataract surgery, which was contaminated with two strains of S. maltophilia. Antibiotic therapy was subsequently changed to trimethoprim/sulfamethoxazol and ciprofloxacin for 30 days, complemented with iv fluocortolone and topical treatment with prednisolone, ciprofloxacin, and chloramphenicol. Twenty-one patients (81%) received pars plana vitrectomy and were additionally treated with intravitreal injections of vancomycin, amikacin and dexamethasone, or imipenem and dexamethasone, respectively. In addition, oxacillin, mezlocillin, and prednisolone were applied subconjunctivally after vitrectomy. Six months after acute infection, a final visual acuity of ≥ 0.2 was achieved by 21/26 patients (80%), a visual acuity of ≥ 0.5 by 14/26 patients (54%). Twenty of 26 patients (77%, 17 of whom had undergone vitrectomy) achieved a higher visual acuity than before surgery. Patients from the vitrectomy group had a median final visual acuity of 0.5 compared to 0.4 in the 5 patients without vitrectomy. There was 1 retinal ablation, 2 intra-retinal bleedings, and relapse of infection in 2/26 patients (8%), with isolation of S. maltophilia in one of the relapsing infection cases.
Empiric antibiotic treatment of PE may not adequately treat rare pathogens such as S. maltophilia. Administration of an effective systemic or intravitreal antibiotic treatment after identification of S. maltophilia may have contributed to the favorable clinical course and relatively low relapse frequency in our patients. Despite the known problem of persistence of S. maltophilia, visual acuity outcome after treatment is comparable to PE induced by other Gram-positive or Gram-negative bacteria.
- 2.Kerr KG, Anson J, Hawkey PM: Adherence of clinical and environmental strains of Xanthomonas maltophilia to plastic material [abstr. B-339]. In: Program and abstracts of the 94th General Meeting of the American Society for Microbiology 1994 (Las Vegas). American Society for Microbiology, Washington DC, 1994.Google Scholar
- 6.Horio N, Horiguchi M, Murakami K, Yamamoto E, Miyake Y: Stenotrophomonas maltophilia endophthalmitis after intraocular lens implantation. Graefes Clin Exp Ophthalmol 2000; 223: 299–301.Google Scholar
- 11.Bader L, Riedel KG, Maydl G, Ritter E, Wirsing von König C, Meroe A, Billing J, Hensel G, Heesemann J: Post-operative Stenotrophomonas maltophilia ocular infections caused by commercially produced contaminated intraocular rinsing solution (in German). Abstract 6 P 6. Annual meeting of Deutsche Gesellschaft für Hygiene und Mikrobiologie, Regensburg, 1999.Google Scholar
- 14.NCCLS: Performance standards for antimicrobial susceptibility testing: M2-A4. National Committee for Clinical Laboratory Standards, Villanova 1999.Google Scholar
- 15.Endophthalmitis Vitrectomy Study Group: Results of the Endophthalmitis Vitrectomy Study A randomised trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 1995; 113: 1479–1496.Google Scholar
- 17.Endophthalmitis Vitrectomy Study Group: Microbiologic factors and visual outcome in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol 1996; 122: 830–846.Google Scholar
- 22.Khadori N, Reuben A, Rosenbaum B, Rolston K, Bodey GP: In vitro susceptibility of Xanthomonas (Pseudomonas) maltophilia to newer antimicrobial agents. Antimicrob Agents Chemother 1990; 34: 1609–10.Google Scholar