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AJ Berman, KE Frank; Post-Operative Burkholderia (Pseudomonas) Cepacia Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4448.
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Purpose: A 53 year old man underwent uncomplicated clear corneal phacoemulsification with uncorrected 20/20 vision postoperative day (POD) #1. Three weeks later, he developed mild irritation, injection, & blurred vision. At ER triage, he was 20/40, falling to 20/400 within 3 hours. There was a 4+ anterior cellular reaction & marked vitreous cell. Methods: Acute post-operative endophthalmitis was diagnosed & a vitreous tap with injection of intravitreal ceftazidime & vancomycin was performed. He was started on oral & topical ciprofloxacin & oral prednisone. Twelve hours later, vision had fallen to hand motions, there was a new hypopyon, & the vitreous was opaque. He underwent a pars plana vitrectomy, revealing white vitreous with posterior membranes, diffusely hemorrhagic retina with white patches, & white vessels covered in fibrin. Additional intravitreal injections of vancomycin, ceftazidime, dexamethasone & ganciclovir were given. On POD #2, the ER tap showed heavy growth of a gram negative rod, & a 3rd vitreous injection with ceftazidime & gentamicin was given. On POD #3, the organism was identified as Burkholderia cepacia. (RESISTANT: ampicillin, cefoperazone, cefotaxime, cefoxitin, ceftriaxone, cephalothin, gentamicin, amikacin, nitrofurantoin, norfloxacin, piperacillin, tetracycline, tobramycin INTERMEDIATE: ciprofloxacin, imipenem SENSITIVE: ceftazidime, trimethoprim, Bactrim) An ID consult was obtained, & a 4th intravitreal injection with ceftazidime & amikacin was given. Later that day, the vitrectomy culture showed heavy growth of B Cepacia with the same resistance pattern. Additional ceftazidime & amikacin were given on POD #5 for worsening vision. On POD #8, vision had improved to 20/200, & the POD #5 culture was negative. A superior, macula-on retinal detachment was noted on POD #12 that required several procedures for permanent retinal reattachment. Results: Vision is 20/20 over 2 years later. Conclusion: B cepacia is a gram negative rod that is highly antibiotic resistant & widely found in the environment. It has become a significant pathogen over the past decade in immunocompromised patients, particularly those with cystic fibrosis, where it can cause the often fatal "Cepacia Syndrome" with septicemia & necrotizing pneumonia. However, it is rarely found outside of the lungs or in immunocompetent hosts. This is the 3rd reported case of an ocular infection due to B Cepacia, & the 1st with a successful outcome. B Cepacia's extreme antibiotic resistance & increasing prevalence make it a pathogen that must be considered early in the differential diagnosis.
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