Korean J Ophthalmol.  2012 Aug;26(4):306-308. 10.3341/kjo.2012.26.4.306.

A Case of Postoperative Endophthalmitis by Extended-spectrum Beta-lactamase-producing Escherichia coli

• Kim YC
• Kim KS

• KMID: 1387400
• DOI: http://doi.org/10.3341/kjo.2012.26.4.306

Abstract

A 75-year-old female was transferred to our clinic three days after uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye that had been carried out at a local clinic. Under the diagnosis of postoperative endophthalmitis, the patient underwent pars plans vitrectomy, IOL explantation, silicone oil tamponade, and intravitreal antibiotic injection. Even after the procedure, the patient's condition was further aggravated, and extended-spectrum beta-lactamase-producing Escherichia coli were identified on bacterial identification test. Although meropenem was applied locally and systemically, the patient had no-light perception visual acuity.

Keyword

Beta-lactamases; Endophthalmitis; Escherichia coli

MeSH Terms

Aged
Anti-Bacterial Agents/therapeutic use
Endophthalmitis/drug therapy/*microbiology
Escherichia coli/*isolation & purification
Female
Humans
Phacoemulsification
Postoperative Complications/diagnosis/*microbiology
Visual Acuity
beta-Lactamases

Figure

• 

  Fig. 1 External ocular surface photography. (A) In the operating room, severe corneal stromal melting and infiltration was observed before surgery. (B) On postoperative day 13, the stromal lysis of the cornea decreased, and neovascularization from the peripheral cornea was noted. (C) On postoperative day 13, corneal epithelialization was observed from the limbus using a fluorescein stain. (D) On postoperative month 2, almost all the corneal surface was conjunctivalized.

Reference

1. Meredith TA. Ryan SJ, Wilkinson CP, editors. Vitrectomy for infectious endophthalmitis. Retina. Vol. 3. Surgical retina. 2006. 4th ed. Philadelphia: Elsevier/Mosby;2255–2276.

2. Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol. 1996. 122:830–846.

3. Major JC Jr, Engelbert M, Flynn HW Jr, et al. Staphylococcus aureus endophthalmitis: antibiotic susceptibilities, methicillin resistance, and clinical outcomes. Am J Ophthalmol. 2010. 149:278–283.e1.

4. Knothe H, Shah P, Krcmery V, et al. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection. 1983. 11:315–317.

5. Philippon A, Labia R, Jacoby G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1989. 33:1131–1136.

6. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study: a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995. 113:1479–1496.

7. Loewenstein A, Zemel E, Lazar M, Perlman I. Drug-induced retinal toxicity in albino rabbits: the effects of imipenem and aztreonam. Invest Ophthalmol Vis Sci. 1993. 34:3466–3476.

8. Axelrod JL, Newton JC, Klein RM, et al. Penetration of imipenem into human aqueous and vitreous humor. Am J Ophthalmol. 1987. 104:649–653.

9. Schauersberger J, Amon M, Wedrich A, et al. Penetration and decay of meropenem into the human aqueous humor and vitreous. J Ocul Pharmacol Ther. 1999. 15:439–445.