Endophthalmitis Caused by<i>Citrobacter</i>Species

Purpose To report predisposing factors, clinical presentation, antibiotic sensitivity, and management of Citrobacter-caused infectious keratitis. Methods We retrospectively reviewed the medical records of culture-proven cases of Citrobacter keratitis in a tertiary referral center for 8 years (from January 2012 to September 2020). Demographic data of the patients, predisposing factors, and presenting signs were extracted. Results Eighteen cases of microbial keratitis due to Citrobacter spp. were identified. The median age of the patients was 66 years (range: 10–89, interquartile range : 59–81). Thirteen patients were male and 5 were female. Multiple predisposing factors were identified in all eyes, including ocular surface disease (n = 8), previous corneal surgery (n = 6), and history of ocular trauma (n = 6). Five patients were diabetic. Corrected distance visual acuity (CDVA) of patients was light perception (LP) in 8 patients, hand motion (HM) in 7, counting fingers (CF) at 1 m in 1, and CF at 2 m in 2 patients. Thirteen eyes exhibited hypopyon. An area of corneal thinning was observed in 7 eyes (38.9%). Endophthalmitis due to infectious keratitis developed in one patient. In vitro susceptibility testing confirmed high sensitivity to ceftazidime and aminoglycosides. Medical management consisted primarily of topical amikacin (20 mg/ml) combined with topical cefazoline (50 mg/ml) (72.2%). Surgical tectonic procedures were carried out in 7 eyes (38.9%). Conclusion Citrobacter spp. is a rare cause of bacterial keratitis.Previous keratoplasty and ocular surface problems are important risk factors. The prognosis is not good and surgical tectonic intervention is required in many cases to resolve the corneal infection.

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“…Citrobacter sp. are rare causes for ocular infections [ 3 , 6 ], and are rarely isolated in patients with bacterial keratitis [ 2 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Citrobacter keratitis: predisposing factors and clinical characteristics

Soleimani

Masoumi

Tabatabaei

et al. 2023

J Ophthal Inflamm Infect

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“…Like other virulent Gram-negative organisms, endophthalmitis caused by Citrobacter species can be associated with a poor visual outcome in spite of maximal treatment. Chen et al [8] reported 6 cases of endophthalmitis caused by Citrobacter species, of which 4 cases were caused by Citrobacter freundii and 2 cases were caused by Citrobacter koseri . Final visual acuity was limited to no light perception in 5 eyes among 6 cases, although maximal medical and surgical treatment were undertaken after diagnosis of endophthalmitis.…”

Section: Discussionmentioning

confidence: 99%

“…Final visual acuity was limited to no light perception in 5 eyes among 6 cases, although maximal medical and surgical treatment were undertaken after diagnosis of endophthalmitis. However, in one case caused by Citrobacter koseri , the patient was able to achieve 20 / 30 vision, according to their report [8]. …”

Section: Discussionmentioning

confidence: 99%

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Late-Onset Citrobacter koseri Endophthalmitis with Suture Exposure after Secondary Intraocular Lens Implantation

Kang

Chung²

2011

Korean J Ophthalmol

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A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.

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“…Whereas endophthalmitis occurs at an average annual incidence of 5 in 10,000 hospitalized cases, only 2% to 15% are endogenous. 14 Other infrequently encountered organisms include Citrobacter, 15 Aeromonas hydrophilia, 16 and nontuberculous mycobacteria. Endogenous endophthalmitis is associated with several medical conditions such as diabetes, lymphoproliferative disease, malignancy, immunosuppression, parenteral alimentation, recent extended surgical procedure, alcoholism, or intravenous drug abuse.…”

Section: Clinical Settings Causative Organisms and Epidemiologymentioning

confidence: 99%

Endogenous Endophthalmitis in the Developing World

Arévalo¹,

Jap²,

Chee³

et al. 2010

International Ophthalmology Clinics

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Endophthalmitis is a rare but potentially devastating intraocular infection that can result from exogenous spread after intraocular surgery, a complication of ocular trauma or from an adjacent ocular interface. A less common form of endophthalmitis; endogenous endophthalmitis is caused by the hematogenous spread of organisms from a remote infectious site to the eye, resulting in severe visual loss. Several large series estimate that endogenous endophthalmitis accounts for 2% to 15% of all cases of endophthalmitis. 1 The possible range of infectious agents is broad and includes Grampositive bacteria, Gram-negative bacteria, and fungi. However, there is considerable variation in the frequency of these pathogens between different geographic areas. Earlier published series of patients with endogenous endophthalmitis have reported the most common bacterial organism as Staphylococcus aureus and the most common fungal organism as Candida species. 2 Endogenous endophthalmitis has been associated with many systemic risk factors, including chronic immune-compromising illnesses (diabetes mellitus, renal failure), indwelling or long-term intravenous catheters, immunosuppressive diseases and therapy [malignancies, www.internat-ophthalmology.com | 173

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Endophthalmitis Caused byCitrobacterSpecies

Abstract: Despite treatment with appropriate antibiotics, Citrobacter endophthalmitis can be associated with a poor visual outcome. Early detection and management may improve the final visual outcome and prevent the possibility of evisceration.

Cited by 17 publications

References 30 publications

Citrobacter keratitis: predisposing factors and clinical characteristics

Citrobacter keratitis: predisposing factors and clinical characteristics

Late-Onset Citrobacter koseri Endophthalmitis with Suture Exposure after Secondary Intraocular Lens Implantation

Endogenous Endophthalmitis in the Developing World

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