STENOTROPHOMONAS MALTOPHILIA ENDOPHTHALMITIS 1 MONTH AFTER INTRAVITREAL AFLIBERCEPT

Triple Gram-negative bacterial endophthalmitis following intravitreal injection

PURPOSE

To describe a puzzling case of endophthalmitis caused by three unusual bacteria after intravitreal injection, its outcome, and underlying questions.

FINDINGS

A 70-year-old female patient was diagnosed with acute endophthalmitis following intravitreal aflibercept injection for age-related macular degeneration. A standard tap and inject procedure was performed. Microbiological analyses on the anterior chamber and vitreous samples yielded the presence of three non-fermenting Gram-negative rods: Pseudomonas stutzeri, Stenotrophomonas maltophilia, and Ochrobactrum anthropi. The outcome was favorable after intravitreal injections of vancomycin and ceftazidime, with an almost complete recovery of the visual acuity to its baseline level. No potential source of infection was identified.

CONCLUSION

Endophthalmitis following intravitreal injection can be caused by a wide variety of bacteria, including some rare Gram-negative species. They can sometimes co-exist in a single patient, but their virulence may vary greatly. Due to the variable antibiotic susceptibility and frequent multiresistance associated with non-fermenting Gram-negative rods, a prompt microbiological approach is required. Favorable outcome can be achieved with standard management.

Stenotrophomonas maltophilia endophthalmitis following keratoplasty

Endophthalmitis is among the most sight-threatening infections in ophthalmology practice. Many microorganisms causing endophthalmitis have been reported. Stenotrophomonas maltophilia is among the rare causes of endophthalmitis and has been reported after cataract surgery, intravitreal injections and ocular trauma. We report a case of S. maltophilia endophthalmitis after keratoplasty, which is a rare entity, in a 63-year-old female patient.

Intraocular lipopolysaccharide examination for early diagnosis of Stenotrophomonas maltophilia endophthalmitis: a case report

This report describes the presence of Stenotrophomonas maltophilia endophthalmitis after phacoemulsification in a 66-year-old woman. The patient presented with ocular redness and pain, as well as hypopyon in the anterior chamber and reduction of visual acuity to hand motion. Intraocular fluid examination revealed a lipopolysaccharide level of >2.5, which suggested bacterial endophthalmitis. The patient was promptly treated with intravitreal ceftazidime 2 mg and vancomycin 1 mg, as well as intravenous infusion of cefuroxime 750 mg, all administered simultaneously at 12-hour intervals. She also received topical levofloxacin eyedrops, once per hour. Subsequently, pathology culture confirmed the presence of the Gram-negative bacillus, S. maltophilia. The presence of lipopolysaccharide in intraocular fluid is an important early indicator of bacterial endophthalmitis, which can provide guidance for clinical treatment.