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Bawankar P, Bhattacharjee H, Barman M, Soibam R, Deka H, Chandra Kuri G, Medhi J. Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution. JOVR [Internet]. 2019Jul.18 [cited 2024Apr.20];14(3):257–266. Available from: https://knepublishing.com/index.php/JOVR/article/view/4781

https://doi.org/10.18502/jovr.v14i3.4781

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  • Cited by 6 articles

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  • Pritam Bawankar

    Pritam Bawankar

    Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Harsha Bhattacharjee

    Harsha Bhattacharjee

    Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Manabjyoti Barman

    Manabjyoti Barman

    Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Ronel Soibam

    Ronel Soibam

    Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Hemalata Deka

    Hemalata Deka

    Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Ganesh Chandra Kuri

    Ganesh Chandra Kuri

    Department of Oculoplastic, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
  • Jnanankar Medhi

    Jnanankar Medhi

    Department of Cornea, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Published Date

  • Jul 18, 2019
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution

Journal of Ophthalmic and Vision Research (JOVR) / July–September 2019, Volume 14, Issue 3 / Pages 257–266

Abstract

Purpose: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes.


Methods: This was a hospital-based, retrospective case study with 13 consecutive patients who had manual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environmental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relationship between bacterial isolates recovered from study patients and contaminated surveillance samples.


Results: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients.


Conclusion: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.

Keywords:

Multidrug Resistance; Pars Plana Vitrectomy; Post-cataract Surgery Endophthalmitis; Pseudomonas Aeruginosa; Small-incision Cataract Surgery

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