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

Bawankar, Pritam; Bhattacharjee, Harsha; Barman, Manabjyoti; Soibam, Ronel; Deka, Hemalata; Kuri, Ganesh Chandra; Medhi, Jnanankar

doi:10.18502/jovr.v14i3.4781

Cited by 16 publications

(21 citation statements)

References 22 publications

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“…This altercation might be due to the low human samples included in the study. Apart from the involvement of a broad range of cytokines, our transcriptomics data revealed the involvement of a large number of chemokines involved in causing a dysregulated immune response, which included CXCL ( 2 , 5 , 9 , 12 – 14 , 16 ), CCL ( 3 , 4 , 6 , 7 , 9 , 12 , 19 , 24 ), and CCR ( 2 , 5 ). While several studies have shown the affiliation of these chemokines with inflammation ( 28 ), not much has been described on its association with MDR P. aeruginosa infection.…”

Section: Discussionmentioning

confidence: 97%

“…This altercation might be due to the low human samples included in the study. Apart from the involvement of a broad range of cytokines, our transcriptomics data revealed the involvement of a large number of chemokines involved in causing a dysregulated immune response, which included CXCL (2,5,9,(12)(13)(14)16), CCL (3,4,6,7,9,12,19,24), and CCR (2,5). While several studies have MDR-PA triggers an initial response which leads to higher infiltration of leukocytes and macrophages in the vitreous cavity, followed by release of cytokines (IL-1b, IL-6, IL-1a, TNF-a, IL-18), chemokines (CXCL-5, CCL-6), MPO, granzyme, and MMPs.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, vision restoration in the case of MDR-PAinduced endophthalmitis is low compared with that of drugsusceptible endophthalmitis (2). In a clinical setting, MDR-Pseudomonas aeruginosa endophthalmitis is often associated with a poor visual prognosis even with early treatment with second line of latest intravitreal antibiotics to which the isolates are susceptible (2,6). Similarly, Parchand et al (7) also reported an overall poor visual outcome in 85.5% of the MDR-PA endophthalmitis cases despite the usage of topical steroids.…”

Section: Introductionmentioning

confidence: 99%

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Transcriptomic and Histological Analysis of Exacerbated Immune Response in Multidrug-Resistant Pseudomonas aeruginosa in a Murine Model of Endophthalmitis

et al. 2022

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Multidrug-resistant (MDR) endophthalmitis is a serious threat to the whole spectrum of therapeutic procedures associated with the risk of managing and preventing vision loss. We have earlier shown the interplay of immune mediators in patients with MDR Pseudomonas aeruginosa (PA) endophthalmitis leading to worse outcome. Expanding on these findings, a murine model of endophthalmitis was developed to explore the effects of drug resistance on the pathogenesis by analyzing the temporal changes in retinal morphology along with its transcriptomic signatures. Clinical isolates of susceptible (S-PA) and multidrug-resistant PA (MDR-PA) were injected intravitreally in C57BL/6 mice followed by enucleation at 6 and 24 h time points postinfection. Disease progression and retinal changes were monitored by clinical and histological assessment and transcriptome analysis in a pair-wise manner. Histological assessment of MDR-PA eyeball revealed higher disease severity (p < 0.05), CD45+ cells (p = 0.007), MPO+ cells (p = 0.01), GFAP+ (p = 0.02), along with higher retinal cell death in mice infected with MDR-PA (p = 0.008). Temporal transcriptome analysis revealed differential expression of nearly 923 genes at 6 h p.i. and 2,220 genes at 24 h p.i. (FC ≥2, adjusted p-value <0.05). Pathway enrichment analysis identified differential regulation of chemokine- and cytokine-mediated, MAPK, and NF-кβ signaling pathways. In conclusion, rapid deterioration of retinal architecture and immune exacerbation was significantly associated with the MDR endophthalmitis, suggesting the need for immunomodulatory agents to strengthen host cell functions and support antibiotics to save the retinal structure from inevitable deterioration and restoration of the vision.

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Section: Discussionmentioning

confidence: 97%

“…This altercation might be due to the low human samples included in the study. Apart from the involvement of a broad range of cytokines, our transcriptomics data revealed the involvement of a large number of chemokines involved in causing a dysregulated immune response, which included CXCL (2,5,9,(12)(13)(14)16), CCL (3,4,6,7,9,12,19,24), and CCR (2,5). While several studies have MDR-PA triggers an initial response which leads to higher infiltration of leukocytes and macrophages in the vitreous cavity, followed by release of cytokines (IL-1b, IL-6, IL-1a, TNF-a, IL-18), chemokines (CXCL-5, CCL-6), MPO, granzyme, and MMPs.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcriptomic and Histological Analysis of Exacerbated Immune Response in Multidrug-Resistant Pseudomonas aeruginosa in a Murine Model of Endophthalmitis

et al. 2022

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“…Outbreaks of P. aeruginosa are mostly attributed to contaminated ophthalmic solutions and devices. 2 Because of the high virulence of this bacterium, the visual outcome is usually disappointingly poor despite prompt therapeutic interventions. A summary of recent relevant studies on post-cataract surgery endophthalmitis outbreaks caused by P. aeruginosa is provided in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

“… 1 Although Gram-negative bacteria are found in only 6% to 29% of cases, major concerns include their more significant role in endophthalmitis outbreaks, high virulence, and undesirable visual outcomes despite immediate treatment. 2 An outbreak of this complication can be catastrophic for both patients and surgeons. Thus, recognition and correction of the cause are necessary in this situation.…”

Section: Introductionmentioning

confidence: 99%

Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

et al. 2021

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Endophthalmitis is the most serious complication of cataract surgery. A cluster of endophthalmitis is a devastating event for surgeons. Pseudomonas aeruginosa is the main causative pathogen of Gram-negative endophthalmitis, which can be suggestive of the occurrence of an outbreak. Ten patients diagnosed with endophthalmitis after cataract surgery performed by one surgeon were analyzed in this study. At presentation, five patients had obvious clinical findings of endophthalmitis with visual acuity of light perception, two patients had poor light perception/no light perception of vision complicated by concomitant keratitis, and three patients had earlier signs of infection (e.g., a lower degree of anterior chamber and vitreous cells, better presenting visual acuity, and greater visibility of the fundus). Investigations revealed that the source of infection was growth of P. aeruginosa on the phaco probe. All of the surgeries had been performed by the same contaminated probe without sterilization between surgeries. This finding emphasizes the importance of strict adherence to sterility protocols during high-risk surgeries such as intraocular surgeries. Additionally, this report aims to emphasize to surgeons that negligence of simple but vital steps of sterility for any reason, such as limitations in time or equipment, can lead to catastrophic events.

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Potential Rare Danger of Presumably Benign Artificial Tears

Prescott

Colby

2023

JAMA Ophthalmol

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Of all the medications we prescribe and procedures we perform as ophthalmologists, artificial tears are generally considered the most benign. The effectiveness of artificial tears is often debated, but until recently, few ophthalmologists had concerns regarding their safety. However, the current outbreak of Verona Integron-mediated Metallo-ßlactamase (VIM) and Guiana-Extended Spectrum-ß-Lactamase (GES)-producing carbapenem-resistant (VIM-GES-CRPA), a rare strain of extensively drug-resistant Pseudomonas aeruginosa, associated with the use of carboxymethylcellulose sodium (Ezri-Care) multidose preservative-free artificial tears may be a wakeup call for the field. The company's website currently states, "Urgent: Discontinue Use of EzriCare Artificial Tears Lubricant Eye Drops (Carboxymethylcellulose Sodium, 10 mg in 1 mL) in ½ fl. oz (15mL) containers (NDC: 79503-0101-15)." 1 This outbreak is a harsh reminder that all eye drops, including artificial tears, are medications with potential adverse effects, most commonly ocular but potentially systemic.Morelli et al 2 present a single case report that is representative of this outbreak. The patient in this report presented with a Pseudomonas aeruginosa-positive corneal ulcer that was complicated by a serous choroidal detachment and led to light perception vision. Although this patient had a history of metastatic breast cancer, her primary risk factor was the use of several over-the-counter multiuse eye drops, including 1 that grew the same strain of P aeruginosa as her corneal culture. This strain of P aeruginosa has not been previously reported in the US, but is similar to a strain previously associated with an endophthalmitis outbreak in India thought to be due to contaminated trypan blue dye. 3 As of February 21, 2023, the US Centers for Disease Control and Prevention (CDC) 4 had reported on 58 patients in 13 states included in the current outbreak, one of whom died. Although the source of infection was a topical eye drop, multiple patients had positive cultures from nonocular sites, including 13 sputum swabs or bronchial washes, 25 rectal swabs, 9 urine cultures, and 2 blood cultures. 4 Preservatives used in topical ophthalmic drops, most commonly benzalkonium chloride, have been associated with ocular surface toxicity, especially in patients using multiple eye drops for extended periods of time. 5 Due to this association, many ophthalmologists, especially cornea specialists, often recommend use of preservative-free eye drops. Traditionally, preservative-free eye drops are dispensed in single-use vials, which ensures sterility but

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

Cited by 16 publications

References 22 publications

Transcriptomic and Histological Analysis of Exacerbated Immune Response in Multidrug-Resistant Pseudomonas aeruginosa in a Murine Model of Endophthalmitis

Transcriptomic and Histological Analysis of Exacerbated Immune Response in Multidrug-Resistant Pseudomonas aeruginosa in a Murine Model of Endophthalmitis

Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

Potential Rare Danger of Presumably Benign Artificial Tears

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