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An outbreak of postoperative gram-negative bacterial endophthalmitis associated with contaminated trypan blue

Rebecca Sunenshine1, Maureen Schultz, Mary G Lawrence

  • 1Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Sunensr@azdhs.gov

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|April 30, 2009
PubMed

Insights

Six patients developed postsurgical endophthalmitis from gram-negative bacteria. Contaminated trypan blue dye from a compounding pharmacy was identified as the source in this outbreak investigation.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Postoperative endophthalmitis is a severe intraocular infection that can lead to vision loss.
  • Gram-negative bacterial infections pose a significant threat in surgical settings.

Observation:

  • Six cases of postsurgical endophthalmitis were identified.
  • All cases were linked to a common source of contamination.

Findings:

  • Cultures from unopened trypan blue dye syringes revealed Pseudomonas aeruginosa and Burkholderia cepacia complex.
  • Pulsed-field gel electrophoresis confirmed that bacterial isolates from the dye were indistinguishable from those found in patients.
  • The identified bacteria were gram-negative.

Implications:

  • Contaminated compounded medications, specifically trypan blue dye, can cause serious postsurgical infections.
  • Compounding pharmacy practices require stringent quality control to prevent microbial contamination.
  • Investigating outbreaks of postoperative endophthalmitis should include assessment of compounded medications.

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