title: Endophthalmitis Caused by Nontuberculous Mycobacterium: Clinical Features, Antimicrobial Susceptibilities, and Treatment Outcomes.
abstract: To report the clinical features, antibiotic susceptibilities and treatment outcomes in patients with endophthalmitis caused by nontuberculous mycobacterium.
  
  
  
  Noncomparative, consecutive case series.
  
  
  
  Retrospective chart review between December 1990 and June 2014.
  
  
  
  In the 19 study patients, the clinical setting of endophthalmitis included post-cataract surgery (7/19, 36.8%), post-glaucoma implant (6/19, 31.6%), post-intravitreal injection (2/19, 10.5%), endogenous endophthalmitis (2/19, 10.5%), post-pars plana vitrectomy (1/19, 5.3%), and post-scleral buckle exposure (1/19, 5.3%). Chronic recurrent or persisting ocular inflammation was present in 15 of 19 patients (78.9%). The species isolated were Mycobacterium chelonae in 14 patients (73.7%), M fortuitum in 3 patients (15.8%), M triplex in 1 patient (5.3%), and M avium intracellulare in 1 patient (5.3%). Antibiotic susceptibilities to tested isolates were the following: amikacin (14/16; 87.5%) and clarithromycin (12/16, 75.0%). Intravitreal injections of amikacin (0.4 mg/0.1 mL) were given in 14 of 19 patients (73.7%) with an average of 7 injections per patient (range, 1-24 injections). Intraocular lens removal was performed for 6 of 7 patients (85.7%) with post-cataract surgery endophthalmitis. All the patients with glaucoma implant (6/6, 100%) underwent implant removal. At last follow-up, 6 of 19 patients (31.6%) had best-corrected visual acuity of 20/400 or better.
  
  
  
  Endophthalmitis caused by nontuberculous mycobacterium often included chronic recurrent or persistent intraocular inflammation and frequently required removal of ocular device (intraocular lens, glaucoma implant, or scleral buckle). The majority of the isolates were susceptible to amikacin and clarithromycin. Visual outcomes in these patients even after treatment were generally poor.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Milan
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Relhan
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ajay E
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Davis
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: talbini@med.miami.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Albini
authors.affiliation: Retina and Uveitis Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Pathengay
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000382:microbiology* / Q000628:therapy*; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009170:Nontuberculous Mycobacteria / Q000187:drug effects / Q000302:isolation & purification*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents