Acute Postoperative Endophthalmitis Caused by Staphylococcus Lugdunensis

Abstract

Purpose:: Bacterial endophthalmitis is among the most feared complications of intraocular surgery and may result in severe vision loss. In studies based on conventional culture techniques, coagulase-negative staphylococci account for more than 80% of all cases. Acute postoperative endophthalmitis caused by Staphylococcus (S.) Lugdunensis is rarely reported in clinical studies.

Methods:: Five cases of acute postcataract surgery endophthalmitis caused by S. Lugdunensis were taken from a multicenter prospective study conducted in four university-affiliated hospitals in France (2004-2005) investigating 129 patients with postoperative endophthalmitis. The aim of the study was to describe the clinical characteristics of endophthalmitis caused by S. Lugdunensis more precisely and to report the usefulness of eubacterial panbacterial Polymerase Chain Reaction (PCR) in the microbiological diagnosis.

Results:: Among 87 bacteriologically documented cases (69%) using eubacterial PCR and/or conventional cultures, S. lugdunensis accounted for 5.7% of the bacterial spectrum and 10% from all staphylococci (n=50). Our cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in 3 cases), and dense infiltration of the vitreous. Each of these patients was initially treated using a standard protocol with intravitreal (vancomycin, ceftazidime), systemic and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria was sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in 4 cases. The final visual prognosis was associated with a high incidence of retinal detachment in 3 of 5 patients after vitrectomy. This rate could be related to the virulence of the S. Lugdunensis leading to panretinal lesions. Final visual acuity ranged from no light perception to 20/20.

Conclusions:: These data suggest that prompt and precise identification of the organism S. Lugdunensis is extremely important so that the appropriate treatment may be administered for a successful outcome. These organisms are also frequently misidentified as S. Aureus because of their morphologic appearance. Early pars plana vitrectomy is often needed in these cases to allow a useful final visual recovery.

Keywords: Staphylococcus • endophthalmitis • low vision