Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops.

Abstract

OBJECTIVE:

To report the clinical presentation and outcomes of cluster postcataract Burkholderia cepacia complex endophthalmitis, the source of infection and clonal relatedness of the isolates.

METHODS:

This was a retrospective study on 13 patients who developed acute postoperative endophthalmitis, along with an infiltrate at the corneal section, after an uneventful cataract surgery with intraocular lens implantation. Aqueous aspirates, vitreous aspirates and environmental surveillance specimens were sampled. Genotypic diversity was determined by PCR using BOX-PCR for each strain, and the clonal relationship was established between clinical and eye drops isolates.

RESULTS:

Vitreous samples showed B. cepacia in cultures in all 13 eyes. Among the samples from various surveillance specimens cultured, topical anaesthetic eye drops grew B. cepacia. The isolates from the patients and the eye drops solution revealed matching banding patterns in BOX-PCR. Isolates from the patients and eye drops were susceptible to cefotaxime and piperacillin/tazobactam only. 9 (69%) patients out of 13 had a final visual acuity of 6/60 or better. Among the remaining four patients, three had a vision of perception of light and one had final vision of 1/60.

CONCLUSIONS:

Microbiology culture and BOX-PCR results revealed contamination of local anaesthetic eye drops and the same organism was cultured from a group of patients with acute-onset postoperative endophthalmitis after an uneventful cataract surgery. Outbreaks may occur in the most vigilant settings, and any sterile consumable may be a common link.

• Authors: Prajna Lalitha, Manoranjan Das, Patwari S Purva, Rajaratinam Karpagam, Manoharan Geetha, Jeganathan Lakshmi Priya, Kannan Naresh Babu
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 98 Issue 11 Pg. 1498-502 (Nov 2014) ISSN: 1468-2079 [Electronic] England
• PMID: 24947905 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Anesthetics, Local
• DNA, Bacterial

Topics

• Acute Disease
• Adult
• Aged
• Anesthetics, Local
• Burkholderia Infections (diagnosis, drug therapy, microbiology)
• Burkholderia cepacia complex (genetics, isolation & purification)
• Cataract Extraction
• DNA, Bacterial (genetics)
• Drug Contamination
• Endophthalmitis (diagnosis, drug therapy, microbiology)
• Eye Infections, Bacterial (diagnosis, drug therapy, microbiology)
• Female
• Genotyping Techniques
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Polymerase Chain Reaction
• Postoperative Complications
• Retrospective Studies
• Vitreous Body (microbiology)