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A Cluster of Corneal Donor Rim Cultures Positive for Achromobacter Species Associated With Contaminated Eye Solution
Camille André1, Marlene L Durand1,2, Thomas Buckley3
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université́ Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France.
Purpose:
To investigate a cluster of corneoscleral rim cultures positive for Achromobacter species over a 6-month period at Massachusetts Eye and Ear.
Methods:
An increased rate of positive corneal donor rim cultures was noted at Massachusetts Eye and Ear between July and December 2017. Positive cultures were subjected to identification and antimicrobial susceptibility testing by phenotypic (MicroScan WalkAway) and genotypic (16S rDNA sequencing) methods. Samples of the eye wash solution (GeriCare) used in the eye bank were also evaluated. Antimicrobial activity of Optical-GS against Achromobacter spp. at 4°C and 37°C was assessed by time-kill kinetics assay.
Results:
Of 99 donor rims cultured, 14 (14.1%) grew bacteria with 11 (78.6%) due to uncommon nonfermenting Gram-negative bacilli. These had been identified by standard automated methods as Achromobacter (n = 3), Alcaligenes (n = 3), Ralstonia (n = 2), Pseudomonas (n = 2), and Stenotrophomonas (n = 1). Eight of these 11 isolates were subsequently available for molecular identification, and all were identified as Achromobacter spp. Six bottles of eyewash solution were evaluated and were positive for abundant Achromobacter spp. (3.4 × 105 ± 1.1 CFU/mL). Optisol-GS had no bactericidal activity against Achromobacter spp. at 4°C after 24-hour incubation but was bactericidal at 37°C. None of the patients who had received the contaminated corneas developed postoperative infection.
Conclusions:
An eyewash solution arising from a single lot was implicated in the contamination of donor rims by Achromobacter spp. The isolates were able to survive in the Optisol-GS medium at the recommended storage temperature. This highlights the need to continue improving protocols for tissue preparation and storage.
Insights
A contaminated eyewash solution caused Achromobacter bacterial contamination in donor corneas. Although the bacteria survived storage, no patients developed infections, emphasizing improved tissue preparation protocols.
Area of Science:
- Ophthalmology
- Microbiology
- Public Health
Background:
- A cluster of corneoscleral rim cultures positive for Achromobacter species was observed.
- This prompted an investigation into potential sources of contamination within the eye bank.
Purpose of the Study:
- To investigate a cluster of corneoscleral rim cultures positive for Achromobacter species.
- To identify the source of contamination and assess the antimicrobial susceptibility of the isolates.
Main Methods:
- Phenotypic and genotypic methods (16S rDNA sequencing) were used for bacterial identification.
- Antimicrobial susceptibility testing and time-kill kinetics assays were performed.
- Samples of eyewash solution were evaluated for bacterial presence.
Main Results:
- 14.1% of donor rims were positive for bacteria, with 11 isolates identified as Achromobacter species via molecular methods.
- The eyewash solution was found to be heavily contaminated with Achromobacter species.
- Optisol-GS demonstrated bactericidal activity against Achromobacter at 37°C but not at 4°C.
Conclusions:
- A single lot of eyewash solution was implicated as the source of Achromobacter contamination.
- Achromobacter species survived in Optisol-GS at recommended storage temperatures.
- The findings underscore the need for enhanced protocols in tissue preparation and storage to prevent microbial contamination.
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