Burkholderia cepacia, a cause of post pars plana vitrectomy silicone oil related endophthalmitis: clinico-pathological presentation and outcome of management

Abstract

AimTo report the long-term outcome of the management of a series of culture proven post pars plana vitrectomy endophthalmitis in which the infective agent was in the silicone oil used as an endotamponade. The isolates were Burkholderia cepacia and Pseudomonas aeruginosa.MethodA retrospective interventional reporting of a series consisting of a cluster of five cases.CasesFive consecutive patients received the same batch of 5000-centistoke silicone oil as endotamponade at the conclusion of vitreoretinal surgery and presented with features of acute intraocular inflammation, which was due to an infective cause. The infective organism isolated from the mixture of silicone oil and fluid was B. cepacia in three out of the initial cluster of four eyes and P. aeruginosa in the fifth eye.Outcome of managementThe initial 4 eyes evolved into eyes with poor vision (hand motion, perception of light and no perception of light), advanced proliferative vitreoretinopathy, hypotony, phthisis bulbi and cornea opacity. The poor visual outcome was deemed to be consequent to delay in removal of the silicone oil, despite use of intravitreal, systemic and topical antibiotics. The fifth case, because of the heightened index of suspicion gained from the preceding four cases, had a prompt removal of the silicone oil, vitreal lavage with antibiotics, and intravitreal injection of antibiotics and steroid. He regained a 6/9 vision.ConclusionGram-negative bacilli can colonize silicone oil resulting in post pars plana vitrectomy endophthalmitis. The index of suspicion for this should be high and can be managed successfully with prompt removal of the silicone oil, microbial sensitive antibiotic lavage of the vitreous cavity, followed by a repeat tamponade.

Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery

“…The current B. contaminans outbreak strain, ST-102, has been involved in several earlier outbreaks related to contaminated pharmaceutical products worldwide, including an outbreak in a haemodialysis unit [28], a nasal spray outbreak [29] and more recently an outbreak due to contaminated liquid docusate sodium [30]. Although BCC contamination of trypan blue dye, local anesthetic eye drops and silicon oil has been identified in outbreaks of endophthalmitis, the underlying source of infection is unknown in most outbreaks of postoperative BCC endophthalmitis, which agrees with our results [11][12][13][14][15][16]. The outpatient clinic conducted an independent investigation to identify the source of infections.…”

“…BCC endophthalmitis is uncommon and most of the reported cases occur after cataract surgery, although cases have also been reported after trauma, corneal transplantation, intravitreal injection and vitrectomy [ 10 – 15 ]. The visual outcomes following BCC endophthalmitis are often poor and many cases result in phthisis, enucleation or visual acuity (VA) of light perception [ 10 , 12 , 14 – 16 ].…”

“…Furthermore, BCC bacteria and in particular B. contaminans are commonly associated with contamination of pharmaceutical products such as nasal sprays, ultrasound gel, hand sanitizers, mouthwash and nebulization solutions [8,9]. BCC endophthalmitis is uncommon and most of the reported cases occur after cataract surgery, although cases have also been reported after trauma, corneal transplantation, intravitreal injection and vitrectomy [10][11][12][13][14][15]. The visual outcomes following BCC endophthalmitis are often poor and many cases result in phthisis, enucleation or visual acuity (VA) of light perception [10,12,[14][15][16].…”

Post intravitreal bevacizumab recurrent Burkholderia cepacia endophthalmitis treated with clear lens extraction in an African

“…This inhibitory effect of silicone oil on microbes has been demonstrated on the following common endophthalmitis causing microbes including Staphylococcus aureus , Staphylococcus epidermidis, Escherichia coli , Pseudomonas aeruginosa , and Candida albicans. 21 This antimicrobial effect of silicone oil is not effective against B. cepacia as reported in a series of silicone oil-related endophthalmitis in which B. cepacia was isolated as the culprit. 21 B. cepacia's resistance to silicone oil use was demonstrated in this case report since silicone oil could not prevent the further growth and recurrence of B. cepacia.…”

“… 21 This antimicrobial effect of silicone oil is not effective against B. cepacia as reported in a series of silicone oil-related endophthalmitis in which B. cepacia was isolated as the culprit. 21 B. cepacia's resistance to silicone oil use was demonstrated in this case report since silicone oil could not prevent the further growth and recurrence of B. cepacia.…”