Acinetobacter baumannii is most often responsible for hospital-acquired infections and is occasionally associated with community-acquired infections. We report two cases of A. baumannii endophthalmitis, one with endogenous endophthalmitis and the other with postkeratoplasty endophthalmitis. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by A. baumannii.
CASE REPORTSCase 1. A 67-year-old female presented with a medical history of hypertension and cardiovascular disease, and a coronary artery bypass graft had been performed 12 years prior to presentation. She complained of a sudden onset of blurry vision and red eyes for 1 day. She had also had fever, chills, poor appetite, diarrhea, and pain in the lower abdomen for 1 week. Her visual acuity was 20/400 in the right eye, and she was able to see hand motion in the left. There was no ocular trauma or history of surgery. On examination, the anterior segments of both eyes demonstrated fine keratic precipitates and fibrin over their pupillary margins. In each eye, the intraocular pressure was 12 mm Hg, and mild nuclear sclerosis was found. An examination of the fundus revealed grade III opacity with peripapillary hemorrhage in both eyes. Results of the laboratory testing showed a white blood cell count of 26.4 ϫ 10 3 /l (89% neutrophils); however, other lab results were within normal limits. Chest roentgenograms, abdominal and gynecological echographs, a barium enema study of the colon, and a computed tomography of the brain were normal. She was treated with initial intravenous antibiotics, including cefazolin (2 g/day) and gentamicin (120 mg/day). On day 3, her visual acuity deteriorated to the ability to see hand motion in the right eye and light perception in the left. Bilateral endogenous endophthalmitis was diagnosed; in addition, vancomycin (1 mg/0.1 ml) and amikacin (0.25 mg/0.1 ml) were intravitreally injected in both eyes immediately.On day 6, blood cultures (Bactec 9240 instrument; Becton, Dickinson and Company, Sparks, MD) revealed the organism Acinetobacter baumannii; however, the results of the urine, aqueous humor, and vitreous cultures were negative. The organism was a nonmotile, oxidase-negative coccobacillus. Moreover, the isolate was identified as A. baumannii on the basis of biochemical testing (API 20E; bioMérieux, Marcy I'Etoile, France). Antibiotic susceptibility testing was determined by broth microdilution methods, and the results are shown in Table 1.On day 10, the inflammation of the vitreous and anterior chambers decreased, and her visual acuity recovered to 20/100 in the right eye and the ability to see hand motion in the left. An afferent pupillary defect was revealed in the left eye. An examination of the fundus showed grade I vitreous opacity in the right eye and grade II vitreous opacity with central retinal arterial occlusion in the left. Four months later, the final visual acuity was 20/60 in the right eye and the ability to see hand motion in the left. Th...
