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Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review

Chung-Ting Wang1, Yin-Hsi Chang2,3, Kuan-Jen Chen2,3

  • 1Department of Medical Education, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.

BMC Infectious Diseases
|March 19, 2022
PubMed
Abstract

Insights

Morganella morganii endophthalmitis after vitrectomy is rare but serious. Early surgical intervention is crucial for vision preservation due to multidrug resistance.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Postvitrectomy endophthalmitis is a rare but severe complication of vitreoretinal surgery.
  • Morganella morganii, a gram-negative rod, is increasingly recognized for causing nosocomial infections.
  • Intraocular Morganella morganii infections are infrequently reported.

Observation:

  • A case of Morganella morganii endophthalmitis following vitrectomy for retinal detachment in an immunocompetent patient is presented.
  • The patient presented with severe vision loss (hand motion), hypopyon, and a retrolental exudative membrane.
  • Initial empirical treatment with intravitreal ceftazidime and vancomycin was ineffective.

Findings:

  • Successful visual recovery to 20/63 was achieved after surgical removal of the retrolental membrane and silicone oil tamponade.
  • Morganella morganii exhibits high multidrug resistance, attributed to ß-lactamase production, genetic mechanisms, and virulence factors.
  • Virulence factors include fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation.

Implications:

  • Morganella morganii's resistance mechanisms can lead to poor outcomes with empirical antibiotic therapy.
  • Early surgical intervention is recommended for Morganella morganii intraocular infections to preserve vision.
  • This case highlights the importance of considering less common pathogens in post-surgical endophthalmitis.
Keywords:
Morganella morganiiPostoperative endophthalmitisRetrolental exudative membraneSilicone oilVitrectomy

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