Posters

Chryseobacterium meningosepticum endophthalmitis following cataract surgery

Poster Details

First Author: K.Lee MALAYSIA

Co Author(s):    S. Singh   V. Subrayan   A. Loo        

Abstract Details

Purpose:

To report a first documented post-operative endophthalmitis caused by Chryseobacterium meningosepticum

Setting:

University Malaya Medical Centre

Methods:

A 65 years old lady with no known premorbids underwent a routine right eye extra capsular cataract extraction (ECCE) for a dense cataract. The surgery was complicated by a small posterior capsule rent from 10-12 o'clock position. Anterior vitrectomy was done and the intraocular lens (Sensar lens, Abbott Medical Optics) was implanted in the bag. Her visual acuity at day one after surgery was 6/24. The immediate postoperative period was uneventful. The patient returned 3 weeks post surgery with complaints of pain and blurring of vision in the right eye. She denied any trauma to the operated eye. Visual acuity was hand movement on presentation with eyelid swelling, diffuse conjunctival injection and chemosis. There was a hypopyon measuring 1.2milimetre. There was no view of fundus and the B-mode orbital ultrasound showed vitreous opacities. Examination of the left eye was unremarkable. A diagnosis of right eye postoperative endophthalmitis was made and the patient was admitted to the ward. Right eye aqueous and vitreous biopsy specimens were obtained and sent for Gram stain with culture and sensitivity testing on blood agar, chocolate agar and Sabouraud's Dextrose agar. 0.1ml of amikacin (0.4mg/0.1ml) and 0.1ml of vancomycin (1mg/0.1ml) was given intravitreally. She was started on intensive topical antibiotics which included moxifloxacin (5mg/ml) and ceftazidime (50mg/ml).

Results:

The Gram stain of the aqueous and vitreous sample did not show any organism. The patient improved clinically over the next few days. The culture result was out on the 6th day of admission as Chryseobacterium meningosepticum. The organism produced yellowish colonies on blood agar and was identified by the conventional biochemical reactions and the API 20NE system. The Gram stain of the organism from the culture showed Gram negative bacilli. The organism was noted to be sensitive to ciprofloxacin and vancomycin. Based on the sensitivity results, intravenous and topical ceftazidime was stopped. She was started on intravenous ciprofloxacin 200mg every 12 hours and topical moxifloxacin was continued. Topical vancomycin (50mg/ml) was added every two hours. Subsequently, she continued to show improvement with regression of the hypopyon. After ten weeks of topical and oral treatment, her vision remained at hand movement despite quiet anterior segment due to multiple vitreous clumps. Right eye pars plana vitrectomy was performed and intra-operatively a macular scar was noted after she relented to the surgical option. Postoperatively her vision improved and three months later her best corrected visual acuity was 6/36. The patient has been stable for the past one year.

Conclusions:

The incidence of endophthalmitis following cataract surgery ranges from 0.08% to 0.12% and Gram negative bacteria are responsible for less than 10% of the total endophthalmitis cases. Chryseobacterium meningosepticum is an aerobic Gram-negative bacillus found primarily in soil and water. It mainly affects newborns and immunocompromised adults. This organism can survive in the aqueous environment and causes infection by inoculation via contaminated medical devices involving fluids. Contaminated surgically implanted devices such as intravascular catheters and prosthetic valves have also been reported in the literature. The immediate treatment for endophthalmitis consists of an urgent aqueous and vitreous tap with intravitreal antibiotics and in our case a combination of intravitreal vancomycin and amikacin was used empirically before the culture results were known. This survey found the newer Fluoroquinolones (garenoxacin, gatifloxacin, and levofloxacin) to be the most appropriate antimicrobials against this pathogen while vancomycin was found not to be a satisfactory therapeutic option. Despite a delay in vitrectomy the vision improved significantly after it was performed, from HM to a final of 6/36. FINANCIAL INTEREST: NONE