Alcaligenes xylosoxidans and Propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye.
OBJECTIVE
To report a case of persistent polymicrobial postoperative endophthalmitis caused by Alcaligenes xylosoxidans and Propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics.


METHODS
Case report.


RESULTS
A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen Eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40.


CONCLUSIONS
Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA.
M K
MK
Rahman
E R
ER
Holz
D000368:Aged; D000421:Alcaligenes / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents; D001082:Aqueous Humor / Q000382:microbiology; D020878:Device Removal; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D009877:Endophthalmitis / Q000382:microbiology* / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000628:therapy; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology* / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000382:microbiology* / Q000628:therapy; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D019591:Pseudophakia / Q000382:microbiology*; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents