title: Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops.
abstract: OBJECTIVE
  To report the clinical presentation and outcomes of cluster postcataract Burkholderia cepacia complex endophthalmitis, the source of infection and clonal relatedness of the isolates.
  
  
  METHODS
  This was a retrospective study on 13 patients who developed acute postoperative endophthalmitis, along with an infiltrate at the corneal section, after an uneventful cataract surgery with intraocular lens implantation. Aqueous aspirates, vitreous aspirates and environmental surveillance specimens were sampled. Genotypic diversity was determined by PCR using BOX-PCR for each strain, and the clonal relationship was established between clinical and eye drops isolates.
  
  
  RESULTS
  Vitreous samples showed B. cepacia in cultures in all 13 eyes. Among the samples from various surveillance specimens cultured, topical anaesthetic eye drops grew B. cepacia. The isolates from the patients and the eye drops solution revealed matching banding patterns in BOX-PCR. Isolates from the patients and eye drops were susceptible to cefotaxime and piperacillin/tazobactam only. 9 (69%) patients out of 13 had a final visual acuity of 6/60 or better. Among the remaining four patients, three had a vision of perception of light and one had final vision of 1/60.
  
  
  CONCLUSIONS
  Microbiology culture and BOX-PCR results revealed contamination of local anaesthetic eye drops and the same organism was cultured from a group of patients with acute-onset postoperative endophthalmitis after an uneventful cataract surgery. Outbreaks may occur in the most vigilant settings, and any sterile consumable may be a common link.
authors.affiliation: Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.affiliation: Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Madurai, India.
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Das
authors.affiliation: Department of Retina, Aravind Eye Hospital, Madurai, India.
authors.forename: Patwari S
authors.initials: PS
authors.lastname: Purva
authors.affiliation: Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India.
authors.forename: Rajaratinam
authors.initials: R
authors.lastname: Karpagam
authors.affiliation: Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India.
authors.forename: Manoharan
authors.initials: M
authors.lastname: Geetha
authors.affiliation: Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India.
authors.forename: Jeganathan
authors.initials: J
authors.lastname: Lakshmi Priya
authors.affiliation: Department of Retina, Aravind Eye Hospital, Madurai, India.
authors.forename: Kannan
authors.initials: K
authors.lastname: Naresh Babu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D019121:Burkholderia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D042602:Burkholderia cepacia complex / Q000235:genetics / Q000302:isolation & purification*; D002387:Cataract Extraction; D004269:DNA, Bacterial / Q000235:genetics; D004340:Drug Contamination; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000779:Anesthetics, Local; D004269:DNA, Bacterial
keywords: Infection; Microbiology