Endophthalmitis caused by Burkholderia cepacia complex (BCC): clinical characteristics, antibiotic susceptibilities, and treatment outcomes.

Flavius A Beca, Jesse D Sengillo, Hailey K Robles-Holmes, Prashanth G Iyer, Darlene Miller, Nicolas A Yannuzzi, Harry W Flynn
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Abstract

Purpose: To report the clinical characteristics, antibiotic susceptibilities, and review the literature of Burkholderia cepacia complex (BCC) associated endophthalmitis.

Study design: Retrospective, observational case series.

Methods: Clinical and microbiology records were reviewed for patients evaluated at the Bascom Palmer Eye Institute and diagnosed wisth culture-confirmed endophthalmitis due to BCC. Antibiotic susceptibility profiles were generated using standard microbiologic protocols via an automated VITEK system.

Results: Endophthalmitis associated with BCC was diagnosed in three patients. Infection occurred in the setting of post-penetrating keratoplasty (PKP), glaucoma filtering surgery, and suspected trauma. All isolates demonstrated in vitro susceptibility to ceftazidime and meropenem. Presenting visual acuity (VA) ranged from hand motion to light perception. Initial treatment strategies included intravitreal ceftazidime (2.25 mg/0.1 mL) and vancomycin (1.0 mg/0.1 mL) injections with fortified topical antibiotics in 2 patients, and surgical debridement of a corneoscleral melt with patch graft along with both topical fortified antibiotics oral antibiotics in the third patient. In all 3 patients, there was no VA improvement at last follow-up, as 2 eyes ultimately underwent enucleation and 1 eye exhibited phthisis bulbi at last follow-up. BCC related endophthalmitis was reviewed among 13 reports. Treatment outcomes were generally poor and antibiotic resistance was common. These BCC isolates cases demonstrated broad resistance patterns, with susceptibilities to ceftazidime (58%), ciprofloxacin (53%), and gentamicin (33%).

Conclusions: Endophthalmitis caused by B. cepacia is a rare clinical entity with generally poor visual outcomes despite prompt treatment with appropriate antibiotics.

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洋葱伯克霍尔德菌复合体(BCC)引起的眼内炎:临床特征、抗生素易感性和治疗结果。
目的:报道洋葱伯克霍尔德菌复合体(BCC)相关性眼内炎的临床特点、抗生素敏感性,并复习相关文献。研究设计:回顾性、观察性病例系列。方法:回顾在Bascom Palmer眼科研究所评估的患者的临床和微生物学记录,这些患者被诊断为经培养证实的BCC眼内炎。通过自动化VITEK系统,使用标准微生物学方案生成抗生素敏感性图谱。结果:3例患者被诊断为与基底细胞癌相关的眼内炎。感染发生在穿透性角膜移植术后(PKP)、青光眼滤过手术和疑似外伤的情况下。所有分离株均显示出对头孢他啶和美罗培南的体外敏感性。呈现的视觉敏锐度(VA)范围从手部运动到光感。最初的治疗策略包括对2名患者进行玻璃体内注射头孢他啶(2.25 mg/0.1 mL)和万古霉素(1.0 mg/0.1 mL。在所有3名患者中,VA在最后一次随访中没有改善,因为2只眼睛最终接受了摘除术,1只眼睛在最后一个随访中出现了球肺结核。在13例报告中回顾了基底细胞癌相关眼内炎。治疗结果普遍较差,抗生素耐药性普遍存在。这些BCC分离株表现出广泛的耐药性,对头孢他啶(58%)、环丙沙星(53%)和庆大霉素(33%)敏感。
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
期刊最新文献
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