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Molecular epidemiology in a cluster of cases of postoperative Pseudomonas aeruginosa endophthalmitis
M Cruciani1, M Malena, G Amalfitano
1Department of Infectious Diseases, University of Verona, Italy.
Abstract:
Between September and October 1994 we observed three cases of Pseudomonas aeruginosa endophthalmitis in a single ophthalmology center. Endophthalmitis progressed rapidly following surgical intervention, and the three patients completely lost vision in the affected eye. Microbiological surveillance culture specimens were obtained from environmental sites, the operating team, intraocular lenses, irrigation fluids, and surgical equipment. P. aeruginosa was isolated from the internal tubing system of automated cataract surgical equipment. The strains of P. aeruginosa cultured from vitreous and anterior chamber specimens of case patients and from the surgical equipment were analyzed with pulsed-field gel electrophoresis. Genomic DNA typing of these isolates showed an identical banding pattern on ethidium bromide-stained gels. We believe that this is the first reported outbreak of P. aeruginosa endophthalmitis traced to automated surgical equipment. Genomic DNA typing emerged as a practical and reliable option for the epidemiological investigation of the outbreak.
Insights
An outbreak of Pseudomonas aeruginosa endophthalmitis occurred following eye surgery. This serious infection, leading to vision loss, was traced to contaminated automated surgical equipment.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Endophthalmitis is a severe intraocular infection that can lead to vision loss.
- Pseudomonas aeruginosa is an opportunistic pathogen that can cause serious infections, particularly in healthcare settings.
Purpose of the Study:
- To investigate an outbreak of Pseudomonas aeruginosa endophthalmitis following cataract surgery.
- To identify the source of the outbreak and implement control measures.
Main Methods:
- Microbiological surveillance cultures were obtained from various sources, including surgical equipment, intraocular lenses, and irrigation fluids.
- Pulsed-field gel electrophoresis (PFGE) was used for genomic DNA typing of Pseudomonas aeruginosa isolates.
- Case patients' vitreous and anterior chamber specimens were analyzed.
Main Results:
- Three cases of rapidly progressing Pseudomonas aeruginosa endophthalmitis were identified.
- Pseudomonas aeruginosa was isolated from the internal tubing system of automated cataract surgical equipment.
- Genomic DNA typing revealed identical banding patterns between patient isolates and the surgical equipment isolates, confirming the source.
Conclusions:
- Automated surgical equipment can be a source of Pseudomonas aeruginosa contamination, leading to endophthalmitis outbreaks.
- Genomic DNA typing is a valuable tool for epidemiological investigations of infectious outbreaks.
- Prompt identification and removal of contaminated equipment are crucial to prevent further cases.