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Published on: February 6, 2021
Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops
Prajna Lalitha1, Manoranjan Das2, Patwari S Purva3
1Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India.
Objective:
To report the clinical presentation and outcomes of cluster postcataract Burkholderia cepacia complex endophthalmitis, the source of infection and clonal relatedness of the isolates.
Methods:
This was a retrospective study on 13 patients who developed acute postoperative endophthalmitis, along with an infiltrate at the corneal section, after an uneventful cataract surgery with intraocular lens implantation. Aqueous aspirates, vitreous aspirates and environmental surveillance specimens were sampled. Genotypic diversity was determined by PCR using BOX-PCR for each strain, and the clonal relationship was established between clinical and eye drops isolates.
Results:
Vitreous samples showed B. cepacia in cultures in all 13 eyes. Among the samples from various surveillance specimens cultured, topical anaesthetic eye drops grew B. cepacia. The isolates from the patients and the eye drops solution revealed matching banding patterns in BOX-PCR. Isolates from the patients and eye drops were susceptible to cefotaxime and piperacillin/tazobactam only. 9 (69%) patients out of 13 had a final visual acuity of 6/60 or better. Among the remaining four patients, three had a vision of perception of light and one had final vision of 1/60.
Conclusions:
Microbiology culture and BOX-PCR results revealed contamination of local anaesthetic eye drops and the same organism was cultured from a group of patients with acute-onset postoperative endophthalmitis after an uneventful cataract surgery. Outbreaks may occur in the most vigilant settings, and any sterile consumable may be a common link.
Insights
Contaminated anesthetic eye drops caused a cluster of Burkholderia cepacia complex endophthalmitis post-cataract surgery. This outbreak highlights how sterile consumables can be a common source of infection, even in careful settings.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Post-cataract surgery endophthalmitis poses a significant risk to vision.
- Burkholderia cepacia complex (BCC) is an opportunistic pathogen that can cause severe infections.
Purpose of the Study:
- To investigate the clinical features and outcomes of a cluster of BCC endophthalmitis following cataract surgery.
- To identify the source of infection and determine the clonal relationship of BCC isolates.
Main Methods:
- Retrospective analysis of 13 patients with acute postoperative endophthalmitis after uneventful cataract surgery.
- Collection and culture of aqueous, vitreous, and environmental samples, including topical anesthetic eye drops.
- Genotypic analysis using BOX-PCR to establish clonal relatedness between clinical and environmental isolates.
Main Results:
- BCC was identified in vitreous cultures from all 13 affected eyes.
- BCC was cultured from topical anesthetic eye drops, with matching BOX-PCR banding patterns to clinical isolates.
- Most patients (69%) achieved a final visual acuity of 6/60 or better, but some experienced severe vision loss.
Conclusions:
- Contamination of topical anesthetic eye drops was identified as the source of the BCC outbreak.
- This outbreak underscores the potential for sterile consumables to act as a common source of infection in ophthalmic surgery.
- Vigilance in sterile supply chain management is crucial to prevent such devastating complications.
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