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Indian Journal of Ophthalmology
Article . 2017 . Peer-reviewed
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Indian Journal of Ophthalmology
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Indian Journal of Ophthalmology
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Stenotrophomonas maltophilia: An emerging entity for cluster endophthalmitis

Authors: Sarita Beri; Anurag Shandil; Rajiv Garg;

Stenotrophomonas maltophilia: An emerging entity for cluster endophthalmitis

Abstract

This was a study of acute cluster endophthalmitis along with clinical features, culture results, and visual outcomes of 10 eyes of 10 patients after intravitreal injection of Avastin (bevacizumab) in one sitting from a single vial.Retrospective review of intravitreal injection of 1.25 mg/0.05 ml bevacizumab that was given to 10 eyes of 10 patients on the same day from a freshly opened vial. All patients manifested with endophthalmitis the next day. Vitreous tap for direct smear and culture was done. Intravitreal antibiotics and steroids were injected and appropriate treatment begun. The injection vial of the same batch was sent for VITEKTM identification and antimicrobial susceptibility of isolates.Endophthalmitis presented within 24 h of intravitreal injection. There was a remarkable absence of posterior pupillary synechia. Two cases were culture-positive (20%), showing pseudomonoid growth. The vial of the same batch revealed a pseudomonoid bacilli Stenotrophomonas maltophilia using VITEKTM, which was resistant to multiple drugs. Hence, the contaminated vial was identified as the source of infection in our case. Among 10 patients, two underwent pars plana vitrectomy. Visual acuity returned to preendophthalmitis levels in 9/10 eyes after 1 month. One patient was lost to follow-up. Late complications included retinal detachment in one case and neovascular glaucoma in another.Early recognition and treatment are key factors in improving outcomes. Causative etiology could be microbial contamination of the drug vial. S. maltophilia should be considered a pathogenic organism of postintravitreal endophthalmitis.

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Keywords

Male, Vascular Endothelial Growth Factor A, intravitreal Avastin, Stenotrophomonas maltophilia, Angiogenesis Inhibitors, VITEKTM, Communicable Diseases, Emerging, Eye Infections, Bacterial, Macular Edema, Retinal Diseases, Humans, Cluster endophthalmitis, Aged, Retrospective Studies, Endophthalmitis, RE1-994, Middle Aged, Anti-Bacterial Agents, Bevacizumab, Vitreous Body, Ophthalmology, Intravitreal Injections, Original Article, Drug Therapy, Combination, Female, Gram-Negative Bacterial Infections

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    influence
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
12
Top 10%
Top 10%
Top 10%
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gold