Ocular Immunology and Inflammation
ISSN: 0927-3948 (Print) 1744-5078 (Online) Journal homepage: http://www.tandfonline.com/loi/ioii20
Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities Khalil Ghasemi Falavarjani MD, Sayyed Amirpooya Alemzadeh MD, Abbas Habibi MD, Ali Hadavandkhani MD, Sareh Askari MD & Arash Pourhabibi MD To cite this article: Khalil Ghasemi Falavarjani MD, Sayyed Amirpooya Alemzadeh MD, Abbas Habibi MD, Ali Hadavandkhani MD, Sareh Askari MD & Arash Pourhabibi MD (2016): Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities, Ocular Immunology and Inflammation, DOI: 10.3109/09273948.2015.1132740 To link to this article: http://dx.doi.org/10.3109/09273948.2015.1132740
Published online: 24 Feb 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioii20 Download by: [University of California, San Diego]
Date: 09 March 2016, At: 10:52
Ocular Immunology & Inflammation, 2016; 00(00): 1–5 © Taylor & Francis Group, LLC ISSN: 0927-3948 print / 1744-5078 online DOI: 10.3109/09273948.2015.1132740
ORIGINAL ARTICLE
Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities Khalil Ghasemi Falavarjani, MD1,2, Sayyed Amirpooya Alemzadeh, MD1, Abbas Habibi, Ali Hadavandkhani, MD1, Sareh Askari, MD1, and Arash Pourhabibi, MD1
Downloaded by [University of California, San Diego] at 10:52 09 March 2016
1
MD
1
,
Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran and 2 Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA
ABSTRACT Purpose: To report the clinical characteristics, antibiotic susceptibilities, and visual outcomes for eyes with endophthalmitis caused by Pseudomonas aeruginosa. Methods: In this retrospective, non-comparative case series, medical records of eyes with culture-proven Pseudomonas aeruginosa endophthalmitis, who were treated from April 2005 to April 2015 at a referral center in Tehran were reviewed. Clinical features, antibiotic susceptibilities, and visual outcomes were assessed. Results: In total, 20 eyes of 19 patients were identified. The clinical settings included cataract surgery (85%), pars plana vitrectomy (5%), endogenous source (5%), and intravitreal bevacizumab injection (5%). Presenting visual acuity ranged from 20/120 to no light perception. Pars plana vitrectomy with intravitreal antibiotic injection was performed as the initial treatment in 16 eyes (80%). The organisms were sensitive to ciprofloxacin and imipenem in 100%; amikacin in 88.3%; ceftazidime in 83.4%; and tobramycin in 83.4% of isolates tested. Final visual acuity was hand motions or worse in 18 eyes (90%). Evisceration was performed in five eyes (20%). Conclusions: Susceptibility to ciprofloxacin and imipenem was found in all isolates tested. Despite appropriate treatment, visual and anatomic outcomes were generally poor. Keywords: Antibiotics, endophthalmitis, Pseudomonas aeruginosa
of eyes with P. aeruginosa endophthalmitis in different clinical settings.6–8 The aim of the present study was to investigate the clinical settings, antibiotic susceptibility, and anatomic and functional outcomes of P. aeruginosa endophthalmitis in a referral center in Tehran.
Infectious endophthalmitis is a devastating ocular infection, which may occur spontaneously or more commonly after intraocular surgery or trauma. The Endophthalmitis Vitrectomy Study reported Grampositive organisms as the most common isolates in postoperative endophthalmitis and isolation of Gramnegative bacteria in only 6% of cases.1 Recent studies, however, reported higher isolation rates for Gramnegative bacteria in referral centers.2–4 Pseudomonas aeruginosa (P. aeruginosa) is an aerobic Gram-negative rod with worldwide distribution. P. aeruginosa can survive in a variety of aqueous solutions, disinfectants, and surgical equipment and is an important source of nosocomial infections.5 Endophthalmitis caused by P. aeruginosa may occur after surgery, trauma, and hematogenous spread, and the treatment outcome is generally poor. Few studies have specifically focused on the characteristics
MATERIALS AND METHODS In this retrospective study, medical records of all patients admitted with a diagnosis of endophthalmitis in the Rassoul Akram Hospital, Tehran, from April 2005 to April 2015 were reviewed, and those with positive cultures for P. aeruginosa and a follow-up period of more than 1 month were selected. Iran University Eye Research Center Ethics Committee approved the study.
Received 22 September 2015; Revised 30 November 2015; Accepted 9 December 2015; published online 25 February 2016 Correspondence: Khalil Ghasemi Falavarjani MD, Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niayesh Street, Tehran 14456– 13131, Iran. E-mail: [email protected]
1
2
K. G. Falavarjani et al.
All isolates were obtained from vitreous samples at the time of antibiotic injection or pars plana vitrectomy. Vitreous samples were obtained under sterile conditions and inoculated onto the blood agar, Sabouraud agar, chocolate agar, and thioglycollate broth, and properly incubated. Antibiotic susceptibility testing was performed by the disk diffusion method. Patient demographics, clinical characteristics, risk factors, treatment strategies, and clinical outcomes were assessed.
Downloaded by [University of California, San Diego] at 10:52 09 March 2016
RESULTS In total, 20 eyes from 19 patients (10 women and 9 men), with a mean age of 66.1 ± 14.8 years (range: 27–83 years) were identified. Five patients had diabetes mellitus, five had hypertension, and one had both diabetes mellitus and hypertension. Table 1 shows the demographics and outcomes of the patients. One patient had bilateral involvement (case numbers 2 and 3, see Table 1). In those patients with preserved eyes, the mean follow-up was 21.9 ± 29.1 months. The most common setting was after cataract surgery in 17 eyes (85%). Endogenous endophthalmitis was associated with diabetes mellitus in one eye (5.3%). The interval between initial surgery and the onset of the endophthalmitis ranged between 1 and 20 days. All patients presented with symptoms of pain and visual loss. With the exception of two cases, which had best corrected visual acuity (BCVA) of 20/120 and 20/160, visual acuity at presentation was light perception or worse. Corneal melting was found in six eyes (30%). Nine eyes (45%) had hypopyon at presentation. Intraocular pressure (IOP) was within normal limits (10–21 mmHg) in 12 eyes (60%). Four eyes had IOP of >21 mmHg and four eyes had IOP
ISSN: 0927-3948 (Print) 1744-5078 (Online) Journal homepage: http://www.tandfonline.com/loi/ioii20
Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities Khalil Ghasemi Falavarjani MD, Sayyed Amirpooya Alemzadeh MD, Abbas Habibi MD, Ali Hadavandkhani MD, Sareh Askari MD & Arash Pourhabibi MD To cite this article: Khalil Ghasemi Falavarjani MD, Sayyed Amirpooya Alemzadeh MD, Abbas Habibi MD, Ali Hadavandkhani MD, Sareh Askari MD & Arash Pourhabibi MD (2016): Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities, Ocular Immunology and Inflammation, DOI: 10.3109/09273948.2015.1132740 To link to this article: http://dx.doi.org/10.3109/09273948.2015.1132740
Published online: 24 Feb 2016.
Submit your article to this journal
Article views: 13
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioii20 Download by: [University of California, San Diego]
Date: 09 March 2016, At: 10:52
Ocular Immunology & Inflammation, 2016; 00(00): 1–5 © Taylor & Francis Group, LLC ISSN: 0927-3948 print / 1744-5078 online DOI: 10.3109/09273948.2015.1132740
ORIGINAL ARTICLE
Pseudomonas aeruginosa Endophthalmitis: Clinical Outcomes and Antibiotic Susceptibilities Khalil Ghasemi Falavarjani, MD1,2, Sayyed Amirpooya Alemzadeh, MD1, Abbas Habibi, Ali Hadavandkhani, MD1, Sareh Askari, MD1, and Arash Pourhabibi, MD1
Downloaded by [University of California, San Diego] at 10:52 09 March 2016
1
MD
1
,
Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran and 2 Doheny Eye Institute, University of California Los Angeles, Los Angeles, California, USA
ABSTRACT Purpose: To report the clinical characteristics, antibiotic susceptibilities, and visual outcomes for eyes with endophthalmitis caused by Pseudomonas aeruginosa. Methods: In this retrospective, non-comparative case series, medical records of eyes with culture-proven Pseudomonas aeruginosa endophthalmitis, who were treated from April 2005 to April 2015 at a referral center in Tehran were reviewed. Clinical features, antibiotic susceptibilities, and visual outcomes were assessed. Results: In total, 20 eyes of 19 patients were identified. The clinical settings included cataract surgery (85%), pars plana vitrectomy (5%), endogenous source (5%), and intravitreal bevacizumab injection (5%). Presenting visual acuity ranged from 20/120 to no light perception. Pars plana vitrectomy with intravitreal antibiotic injection was performed as the initial treatment in 16 eyes (80%). The organisms were sensitive to ciprofloxacin and imipenem in 100%; amikacin in 88.3%; ceftazidime in 83.4%; and tobramycin in 83.4% of isolates tested. Final visual acuity was hand motions or worse in 18 eyes (90%). Evisceration was performed in five eyes (20%). Conclusions: Susceptibility to ciprofloxacin and imipenem was found in all isolates tested. Despite appropriate treatment, visual and anatomic outcomes were generally poor. Keywords: Antibiotics, endophthalmitis, Pseudomonas aeruginosa
of eyes with P. aeruginosa endophthalmitis in different clinical settings.6–8 The aim of the present study was to investigate the clinical settings, antibiotic susceptibility, and anatomic and functional outcomes of P. aeruginosa endophthalmitis in a referral center in Tehran.
Infectious endophthalmitis is a devastating ocular infection, which may occur spontaneously or more commonly after intraocular surgery or trauma. The Endophthalmitis Vitrectomy Study reported Grampositive organisms as the most common isolates in postoperative endophthalmitis and isolation of Gramnegative bacteria in only 6% of cases.1 Recent studies, however, reported higher isolation rates for Gramnegative bacteria in referral centers.2–4 Pseudomonas aeruginosa (P. aeruginosa) is an aerobic Gram-negative rod with worldwide distribution. P. aeruginosa can survive in a variety of aqueous solutions, disinfectants, and surgical equipment and is an important source of nosocomial infections.5 Endophthalmitis caused by P. aeruginosa may occur after surgery, trauma, and hematogenous spread, and the treatment outcome is generally poor. Few studies have specifically focused on the characteristics
MATERIALS AND METHODS In this retrospective study, medical records of all patients admitted with a diagnosis of endophthalmitis in the Rassoul Akram Hospital, Tehran, from April 2005 to April 2015 were reviewed, and those with positive cultures for P. aeruginosa and a follow-up period of more than 1 month were selected. Iran University Eye Research Center Ethics Committee approved the study.
Received 22 September 2015; Revised 30 November 2015; Accepted 9 December 2015; published online 25 February 2016 Correspondence: Khalil Ghasemi Falavarjani MD, Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niayesh Street, Tehran 14456– 13131, Iran. E-mail: [email protected]
1
2
K. G. Falavarjani et al.
All isolates were obtained from vitreous samples at the time of antibiotic injection or pars plana vitrectomy. Vitreous samples were obtained under sterile conditions and inoculated onto the blood agar, Sabouraud agar, chocolate agar, and thioglycollate broth, and properly incubated. Antibiotic susceptibility testing was performed by the disk diffusion method. Patient demographics, clinical characteristics, risk factors, treatment strategies, and clinical outcomes were assessed.
Downloaded by [University of California, San Diego] at 10:52 09 March 2016
RESULTS In total, 20 eyes from 19 patients (10 women and 9 men), with a mean age of 66.1 ± 14.8 years (range: 27–83 years) were identified. Five patients had diabetes mellitus, five had hypertension, and one had both diabetes mellitus and hypertension. Table 1 shows the demographics and outcomes of the patients. One patient had bilateral involvement (case numbers 2 and 3, see Table 1). In those patients with preserved eyes, the mean follow-up was 21.9 ± 29.1 months. The most common setting was after cataract surgery in 17 eyes (85%). Endogenous endophthalmitis was associated with diabetes mellitus in one eye (5.3%). The interval between initial surgery and the onset of the endophthalmitis ranged between 1 and 20 days. All patients presented with symptoms of pain and visual loss. With the exception of two cases, which had best corrected visual acuity (BCVA) of 20/120 and 20/160, visual acuity at presentation was light perception or worse. Corneal melting was found in six eyes (30%). Nine eyes (45%) had hypopyon at presentation. Intraocular pressure (IOP) was within normal limits (10–21 mmHg) in 12 eyes (60%). Four eyes had IOP of >21 mmHg and four eyes had IOP
