Fluorescent amplified fragment length polymorphism (FAFLP) genotyping demonstrates the role of biofilm-producing methicillin-resistant periocular Staphylococcus epidermidis strains in postoperative endophthalmitis

BACKGROUND: An observational case series was used to study the virulence characteristics and genotypes of paired Staphylococcus epidermidis isolates cultured from intraocular samples and from periocular environment of patients with postcataract surgery endophthalmitis. METHODS: Eight S. epidermidis isolates were obtained from three patients (2 from patients #1 and 2 and 4 from patient #3) whose vitreous and/or anterior chamber (AC) specimens and preoperative lid/conjunctiva samples were culture positive. Cultures were identified by API-Staph phenotypic identification system and genotypically characterized by Fluorescent Amplified Fragment Length Polymorphism (FAFLP) and checked for their antimicrobial susceptibility. The isolates were tested for biofilm-production and methicillin-resistance (MR) by PCR amplification of icaAB and mecA gene respectively. RESULTS: Four out of eight S. epidermidis strains showed multiple drug resistance (MDR). All the eight strains were PCR positive for mecA gene whereas seven out of eight strains were positive for icaAB genes. In all three patients FAFLP typing established vitreous isolates of S. epidermidis strains to be indistinguishable from the strains isolated from the patient's conjunctival swabs. However, from patient number three there was one isolate (1030b from lid swab), which appeared to be nonpathogenic and ancestral having minor but significant differences from other three strains from the same patient. This strain also lacked icaAB gene. In silico analysis indicated possible evolution of other strains from this strain in the patient. CONCLUSION: Methicillin-resistant biofilm positive S. epidermidis strains colonizing the conjunctiva and eyelid were responsible for postoperative endophthalmitis (POE)

Treatment of two postoperative endophthalmitis cases due to Aspergillus flavus and Scopulariopsis spp. with local and systemic antifungal therapy

<p>Abstract</p> <p>Background</p> <p>Endophthalmitis is the inflammatory response to invasion of the eye with bacteria or fungi. The incidence of endophthalmitis after cataract surgery varies between 0.072–0.13 percent. Treatment of endophthalmitis with fungal etiology is difficult.</p> <p>Case Presentation</p> <p><b>Case 1: </b>A 71-year old male diabetic patient developed postoperative endophthalmitis due to <it>Aspergillus flavus</it>. The patient was treated with topical amphotericin B ophthalmic solution, intravenous (IV) liposomal amphotericin-B and caspofungin following vitrectomy.</p> <p><b>Case 2: </b>A 72-year old male cachectic patient developed postoperative endophthalmitis due to <it>Scopulariopsis </it>spp. The patient was treated with topical and IV voriconazole and caspofungin.</p> <p>Conclusion</p> <p><it>Aspergillus </it>spp. are responsible of postoperative fungal endophthalmitis. Endophthalmitis caused by <it>Scopulariopsis </it>spp. is a very rare condition. The two cases were successfully treated with local and systemic antifungal therapy.</p

Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia.

This retrospective report presents a series of patients with endogenous endophthalmitis treated over a 13-y period in a tertiary care centre in South Australia. 16 eyes of 13 patients (8 M, 5F) with a mean age 62 y were included. Systemic predisposing risk factors were mainly diabetes mellitus (30.7%), chronic obstructive airway disease (23.1%) and end-stage renal disease (15.4%). Isolated organisms included fungal species in 11 eyes (7 eyes with Candida albicans and 4 with Aspergillus fumigatus), Gram-positive isolates in 4 eyes, and Pseudomonas aeruginosa in 1 eye. Presenting visual acuity was 20/200 or lower in 8 patients (61.5%). Final visual improvement of more than 2 lines was noted in 5 patients, it was stable or worse in 6 patients and in 2 patients the eye was either enucleated or eviscerated. Systemic aspergillosis resulted in death of both patients. In conclusion, the clinical course and microbiological profile of pathogens in patients with endogenous endophthalmitis in our series are similar to other recent western reports. Candida species are the leading isolates, with an overall poor visual prognosis, especially in Aspergillus infections. Close monitoring of immune-compromized patients with systemic infections may enable early diagnosis and treatment and improve prognosis.Igal Leibovitch, Tze Lai, Grant Raymond, Ramin Zadeh, Francis Nathan and Dinesh Selv

Survival of bacteria on the ocular surface following double application of povidone-iodine before cataract surgery

Aims: This study assessed the effectiveness of one vs two applications of povidone-iodine in decontaminating the eye before cataract surgery. Methods: This was a prospective, interventional study of 52 patients having elective unilateral phacoemulsification cataract surgery in a tertiary care centre. Each patient had two applications of povidone-iodine before phacoemulsification cataract surgery, separated by 10 min. Conjunctival swabs were taken before and after each application and cultured in 5% CO2 and anaerobically. Statistical analysis was performed using McNemar's test for correlated proportions. Results: In all, 15 of 52 (29%) patients had positive cultures before the first application and 21 of 52 (40%) patients had positive cultures after it. This was not statistically significant (P=0.239). A total of 25 of 52 (48%) patients were culture positive before the second application. This was not statistically significantly different from 10 min earlier (P=0.423). Six of 52 (12%) patients were positive after the second application (P<0.001). Conclusions: We conclude that the initial application of povidone-iodine was not effective in decontaminating the eye. Recontamination did not take place between applications. The difference in the proportion of patients with positive results before and after the second application of povidone-iodine was statistically significant. We infer from this that double application of povidone-iodine before cataract surgery is advisable.CV Stranz, GE Fraenkel, AR Butcher, AJ Esterman and MJ Goggi

Microbial profile and antibiotic susceptibility of culture-positive bacterial endophthalmitis

Purpose To assess the distribution of microorganisms isolated from patients with bacterial endophthalmitis and their antimicrobial susceptibility.Methods Retrospective analysis of medical and microbiological records of patients with suspected diagnosis of endophthalmitis. the following information was assessed: number of presumed and culture-positive endophthalmitis cases, source of infection, microbiological result (aqueous and/or vitreous culture and Gram staining), microbial characterization and distribution, and antimicrobial susceptibility.Results A total of 107 (46%) of 231 patients with bacterial endophthalmitis showed positive results by gram stain or culture. of these, 97 (42%) patients were positive for culture only. Most of them (62%) were secondary to a surgical procedure (postoperative), 12% were posttraumatic and 26% were secondary to an unknown source or the data were unavailable. A total of 100 microorganisms were isolated (38 aqueous and 67 vitreous samples) from the 97 culture-positive cases (91% were gram-positive and 9% were gram-negative). Coagulase-negative Staphylococcus (CoNS) (48%) were the most frequently isolated, followed by Stretococcus viridans (18%), and Staphylococcus aureus (13%). the antimicrobial susceptibility for CoNS was as follows: amikacin-91.6%, cephalothin-97.9%, ceftriaxone-50%, ciprofloxacin-62.5%, chloramphenicol-91.8%, gatifloxacin-79.5%, gentamicin-72.9%, moxifloxacin-89.5%, ofloxacin-70.8%, oxacillin-58.3%, penicillin-33.3%, tobramycin-85.4%, and vancomycin-100%.Conclusion Gram-positive bacteria were the major causes of infectious endophthalmitis in this large series, usually following surgery. CoNS was the most common isolate. of interest, susceptibility to oxacillin and fourth-generation quinolones was lower than previously published. Eye (2011) 25, 382-388; doi:10.1038/eye.2010.236; published online 18 February 2011Universidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo, Special Lab Clin Microbiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo, Special Lab Clin Microbiol, São Paulo, BrazilWeb of Scienc