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Jung, Kang, and Chin: Two Different Cases of Stenotrophomonas Maltophilia Endophthalmitis after Cataract Surgery
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(1): 161-167.

Published online: 16 January 2012

DOI: https://doi.org/10.3341/jkos.2012.53.1.161

Two Different Cases of Stenotrophomonas Maltophilia Endophthalmitis after Cataract Surgery

Ji Won Jung, MD, Haeng Ku Kang, MD, Hee Seung Chin, MD, PhD

Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea.

Address reprint requests to Hee Seung Chin, MD, PhD. Department of Ophthalmology, Inha University Hospital, #7-206 Sinheung-dong 3-ga, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890-3408, Fax: 82-32-890-2403, hschin@inha.ac.kr

Received 14 June 2011       Accepted 18 November 2011

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To report 2 different cases of postoperative endophthalmitis caused by Stenotrophomonas maltophilia after cataract surgery.

Case summary

A 73-year-old male with diabetes mellitus developed severe pain in the right eye 2 weeks after cataract surgery. The patient was hospitalized with a diagnosis of infectious endophthalmitis, and vitrectomy was performed. Cultures of aqueous humor and vitreous aspirate revealed S. maltophilia. On day 30 after vitrectomy, his visual acuity had improved to 20/20 and there were no recurrences. A 61-year-old female with no significant past medical history was referred for uveitis or delayed onset endophthalmitis 30 days after cataract surgery. An anterior chamber tapping and cultures were performed. S. maltophilia and Aspergillus fumigatus were isolated. The patient received antibiotics and antifungal agents and her visual acuity improved to 20/25.

Conclusions

S. maltophilia has been considered a life-threatening systemic opportunistic infection; however, the organism has recently been reported as an exogenous pathogen of endophthalmitis following cataract surgery. Herein, 2 different cases of S. maltophilia endophthalmitis after cataract surgery are presented and compared with previous case reports.

Keywords: Aspergillus fumigatus, Coinfection, Postoperative endophthalmitis, Stenotrophomonas maltophilia

Figures and Tables

Figure 1
(A) Initial Fundus photographs are not visible fundus details due to media opacity in the right eye (B) Normal fundus in the left eye.
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Figure 2
In vitro antibiotic sensitivities of Stenotrophomonas maltophila in Case 1, 2. S = sensitive; R = resistant.
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Figure 3
Time course of the clinical course and treatment (A) Case 1 (B) Case 2. Cat OP = cataract operation; Inj. = injection; PPV = pars plana vitrectomy; VA = visual acuity; BCVA = best corrected visual acuity; HM = hand motion; F-Amphotericin = fortified amphotericin.
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Table 1
Characteristics in Stenotrophomonas maltophilia endophthalmitis after cataract surgery in case and case series
jkos-53-161-i001

DMN = diabetic nephropathy; MTX = methotrexate; Phaco c IOL = phacoemulsification with intraocular lens implantation; ECCE c PCL implantation = extracapsular cataract extraction with posterior chamber lens implantation; Trabe = trabeculectomy; PPV = pars plana vitrectomy; VA = visual acuity; LP = light perception; HM = hand motion; CF = count fingers.

*Not mentioned in the literature, †Cases in this report.

References

1. Kim JH. Infectious endophthalmitis, Cataract. 2002. 1st ed. Seoul: Il Jo Kak;264–272.
2. Jung JY, Ko BY, Kim BY. Factors associated with a poor visual result in acute endophthalmitis after cataract surgery. J Korean Ophthalmol Soc. 2008. 49:1242–1247.
3. Jucker BA, Harms H, Zehnder AJ. Adhesion of the positively charged bacterium Stenotrophomonas (Xanthomonas) maltophilia 70401 to glass and Teflon. J Bacteriol. 1996. 178:5472–5479.
4. Chen S, Stroh EM, Wald K, Jalkh A. Xanthomonas maltophilia endophthalmitis after implantation of sustained-release ganciclovir. Am J Ophthalmol. 1992. 114:772–773.
5. Kaiser GM, Tso PC, Morris R, McCurdy D. Xanthomonas maltophilia endophthalmitis after cataract extraction. Am J Ophthalmol. 1997. 123:410–411.
6. Chaudhry NA, Flynn HW Jr, Smiddy WE, Miller D. Xanthomonas maltophilia endophthalmitis after cataract surgery. Arch Ophthalmol. 2000. 118:572–575.
7. Horio N, Horiguchi M, Murakami K, et al. Stenotrophomonas maltophilia endophthalmitis after intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol. 2000. 238:299–301.
8. Benian O, Alimgil L, Erda N. Two cases of Stenotrophomonas maltophilia endophthalmitis. Ophthalmic Surg Lasers. 2002. 33:253–256.
9. Karakurt A, Abdik O, Sengun A, et al. Stenotrophomonas maltophilia Endophthalmitis after cataract extraction. Ocul Immunol Inflamm. 2006. 14:41–46.
10. Horster S, Bader L, Seybold U, et al. Stenotrophomonas maltophilia induced post-cataract-surgery endophthalmitis: Outbreak investigation and clinical courses of 26 patients. Infection. 2009. 37:117–122.
11. Seong YS, Koh HJ, Kwon OW. A case of stenotrophomonas maltophilia endophthalmitis after cataract operation. J Korean Ophthalmol Soc. 2001. 42:186–190.
12. Davin-Regli A, Bollet C, Auffray JP, et al. Use of random amplified polymorphic DNA for epidemiological typing of Stenotrophomonas maltophilia. J Hosp Infect. 1996. 32:39–50.
13. Muder RR, Harris AP, Muller S, et al. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis. 1996. 22:508–512.
14. Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. 1998. 11:57–80.
15. Muder RR. Optimizing therapy for Stenotrophomonas maltophilia. Semin Respir Crit Care Med. 2007. 28:672–677.
16. Baratz KH, Hattenhauer MG. Indiscriminate use of corticosteroid-containing eyedrops. Mayo Clin proc. 1999. 74:362–366.
17. Tanure MA, Cohen EJ, Sudesh S, et al. Spectrum of fungal keratitis at Wills Eye Hospital, Philadelphia, Pennsylvania. Cornea. 2000. 19:307–312.
18. Weishaar PD, Flynn HW Jr, Murray TG, et al. Endogenous Aspergillus endophthalmitis. Clinical features and treatment outcomes. Ophthalmology. 1998. 105:57–65.
19. Anand AR, Therese KL, Madhavan HN. Spectrum of aetiological agents of postoperative endophthalmitis and antibiotic susceptibility of bacterial isolates. Indian J Ophthalmol. 2000. 48:123–128.
20. Narang S, Gupta A, Gupta V, et al. Fungal endophthalmitis following cataract surgery: clinical presentation, microbiological spectrum, and outcome. Am J Ophthalmol. 2001. 132:609–617.
21. Fox GM, Joondeph BC, Flynn HW Jr, et al. Delayed-onset pseudophakic endophthalmitis. Am J Ophthalmol. 1991. 111:163–173.
22. Ho PC, Tolentino Fl, Baker AS. Successful treatment of exogenous aspergillus endophthalmitis: a case report. Br J Ophthalmol. 1984. 68:412–415.
23. Penland RL, Wilhelmus KR. Stenotrophomonas maltophilia ocular infections. Arch Ophthalmol. 1996. 114:433–436.
24. Cho BJ. A case of corneal ulcer caused by combined infection of Stenotrophomonas maltophilia and Aspergillus fumigatus. J Korean Ophthalmol Soc. 2000. 41:1242–1246.
25. Kim JH, Shin HH, Song JS, Kim HM. Infectious keratitis caused by Stenotrophomonas maltophilia and yeast simultaneously. Cornea. 2006. 25:1234–1236.
26. Mett H, Rosta S, Schacher B, Frei R. Outer membrane permeability and beta-lactamase content in Pseudomonas maltophilia clinical isolates and laboratory mutants. Rev Infect Dis. 1988. 10:765–769.
27. San Gabriel P, Zhou J, Tabibi S, et al. Antimicrobial susceptibility and synergy studies of Stenotrophomonas maltophilia isolates from patients with cystic fibrosis. Antimicrob Agents Chemother. 2004. 48:168–171.
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