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Published on: February 6, 2021
Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular
Raul Velez-Montoya1, Dulce Rascón-Vargas, William F Mieler
1Retina Department, Associacition to prevent blindness in México IAP, México City, Mexico.
Abstract:
Purpose. To describe the clinical characteristics, diagnosis, and treatment with intravitreal ampicillin sodium of a postoperative endophthalmitis case due to Streptococcus uberis; an environmental pathogen commonly seen in mastitis cases of lactating cows. Methods. Case Report. A 52-year-old, Hispanic diabetic patient who suddenly developed severe pain and severe loss of vision, following vitrectomy. Results. The patient was diagnosed with postoperative endophthalmitis secondary to a highly resistant strain of Streptococcus uberis that did not respond to intravitreal antibiotics. He was treated with an air-fluid interchange, anterior chamber washout, intravitreal ampicillin sodium (5 mg/0.1 mL), and silicon oil tamponade (5000 ck). The eye was anatomically stabilized, though there was no functional recovery. Conclusion. Streptococcus uberis is an uncommon pathogen to the human eye, which has unique features that help the strain in developing resistance to antibiotics. While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.
Insights
A rare eye infection, Streptococcus uberis endophthalmitis, occurred post-surgery. Treatment with intravitreal ampicillin sodium showed limited success, highlighting antibiotic resistance challenges in ocular infections.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Postoperative endophthalmitis is a severe intraocular infection following eye surgery.
- Streptococcus uberis, typically associated with bovine mastitis, is an uncommon cause of human endophthalmitis.
Observation:
- A 52-year-old diabetic patient developed severe pain and vision loss after vitrectomy.
- The patient was diagnosed with postoperative endophthalmitis caused by a highly resistant strain of Streptococcus uberis.
Findings:
- Standard intravitreal antibiotics were ineffective against the resistant Streptococcus uberis strain.
- Treatment involved surgical intervention, anterior chamber washout, and intravitreal ampicillin sodium with silicon oil tamponade.
- While the eye was anatomically stabilized, functional vision recovery was not achieved.
Implications:
- This case highlights the potential for unusual pathogens like Streptococcus uberis to cause severe ocular infections.
- The unique resistance mechanisms of this pathogen pose treatment challenges.
- Intravitreal ampicillin sodium is a potential treatment, but its efficacy and toxicity require further investigation.
