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Alcaligenes xylosoxidans and Propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye
1Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA.
Purpose:
To report a case of persistent polymicrobial postoperative endophthalmitis caused by Alcaligenes xylosoxidans and Propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics.
Methods:
Case report.
Results:
A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen Eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40.
Conclusion:
Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.
Insights
Persistent polymicrobial endophthalmitis caused by Alcaligenes xylosoxidans and Propionibacterium acnes after cataract surgery can be challenging. Aggressive treatment, including vitrectomy and explantation, may be necessary for resistant infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Postoperative endophthalmitis is a serious complication following cataract surgery.
- Polymicrobial infections can present unique diagnostic and therapeutic challenges.
Observation:
- A case of persistent polymicrobial endophthalmitis involving Alcaligenes xylosoxidans and Propionibacterium acnes in a pseudophakic eye is presented.
- The patient experienced recrudescence of infection despite initial broad-spectrum antibiotic treatment.
- Alcaligenes xylosoxidans, a gram-negative bacterium, demonstrated resistance to multiple antibiotics.
Findings:
- Cultures confirmed polymicrobial infection with A. xylosoxidans and P. acnes.
- A. xylosoxidans was identified as the persistent pathogen requiring aggressive management.
- Successful resolution was achieved with pars plana vitrectomy and intraocular lens explantation.
Implications:
- This case highlights the potential for chronic endophthalmitis caused by resistant organisms after cataract extraction.
- Early recognition and aggressive surgical intervention, including lens and capsule removal, may be crucial for managing such infections.
- Understanding the role of specific pathogens like A. xylosoxidans in resistant endophthalmitis is vital for treatment strategies.
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