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Published on: February 6, 2021
Clinical settings, management and factors affecting outcomes in multi and extensively-drug resistant Pseudomonas
Srishti Raksheeth Ramamurthy1,2, Joveeta Joseph3, Vivek Pravin Dave1
1Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Purpose:
To report the clinical settings, management and factors affecting outcomes in multi-drug resistant (MDR) and extensively-drug resistant (XDR) Pseudomonas endophthalmitis.
Settings:
Retrospective, consecutive, non-comparative interventional case series. Cases of MDR and XDR Pseudomonas endophthalmitis from January 2012 to December 2020 treated at our tertiary eye care center were included. Data collected included clinical data, anatomic and functional outcome, isolated micro-organisms, and culture sensitivity.
Results:
This study included 29 eyes of 29 patients with MDR/XDR Pseudomonas endophthalmitis. Mean age at presentation was 60.27 ± 14.9 years (median 63). Commonest clinical setting was acute post-operative endophthalmitis in 27 cases (93.1%). Concurrent corneal infiltrate was present in 11 eyes (37.9%). Initial intervention in 19 eyes (65.5%) was vitrectomy, 2 of which underwent endoscopic pars plana vitrectomy. Mean number of interventions was 3.34 ± 1.44 (median 4). Mean follow up was 3.25 ± 3.07 months (median 2). Sensitivity to ceftazidime was 48.28%. All isolates were sensitive to colistin. Mean visual acuity at last follow up in logMAR was 2.64 ± 1.48 (median 3.5). Seven eyes (24.13%) were NPL (nil perception of light) at the last follow up. Two eyes (6.9%) underwent evisceration. Nine eyes (31.03%) had a favourable anatomic and functional outcome. Eyes without a corneal infiltrate at presentation were found to have a favourable anatomic and favourable functional outcome (OR 11.91, P < 0.04, CI 1.08 to 130.93).
Conclusion:
Corneal involvement at presentation is associated with poorer outcomes in MDR and XDR Pseudomonas endophthalmitis. There is a potential role of higher newer antibiotics especially colistin in the management of these cases.
Insights
Outcomes for multi-drug resistant (MDR) and extensively-drug resistant (XDR) Pseudomonas endophthalmitis are poorer with corneal involvement. Colistin shows potential in managing these challenging infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Multi-drug resistant (MDR) and extensively-drug resistant (XDR) *Pseudomonas* infections pose significant challenges in clinical management.
- Endophthalmitis, an inflammation of the eye's interior, can lead to severe vision loss, especially when caused by resistant pathogens.
Purpose of the Study:
- To investigate the clinical characteristics, management strategies, and outcome determinants for patients with MDR and XDR *Pseudomonas* endophthalmitis.
- To identify factors associated with favorable or unfavorable outcomes in these severe ocular infections.
Main Methods:
- A retrospective, consecutive, non-comparative interventional case series was conducted.
- Data from 29 patients with MDR/XDR *Pseudomonas* endophthalmitis treated between 2012 and 2020 were analyzed.
- Clinical data, visual acuity, anatomical outcomes, and microbial culture sensitivity were collected and reviewed.
Main Results:
- The study included 29 eyes; 93.1% of cases were acute post-operative endophthalmitis.
- Favorable anatomic and functional outcomes were observed in 31.03% of eyes.
- Absence of corneal infiltrate at presentation was significantly associated with better outcomes (OR 11.91, P < 0.04).
- All isolates were sensitive to colistin, while sensitivity to ceftazidime was 48.28%.
Conclusions:
- Corneal involvement at presentation is a predictor of poorer outcomes in MDR/XDR *Pseudomonas* endophthalmitis.
- Higher-generation antibiotics, particularly colistin, may play a crucial role in managing these resistant infections.
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