Endophthalmitis cluster linked to eye drops

This article reports on a post-cataract surgery endophthalmitis outbreak at a single institution caused by local anesthetic eye drops contaminated with B. cepacia.

The authors reviewed the charts of 13 patients from a single institution who developed acute postoperative endophthalmitis along with an infiltrate at the corneal section over a three-month period after uneventful cataract surgery with IOL implantation.

Vitreous samples showed B. cepacia in cultures in all 13 eyes. Among the samples from various surveillance specimens cultured, topical anesthetic 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.

Although the infections persisted for about a year, endophthalmitis resolved and nearly 70% of patients regained functional vision. They note that the time to presentation of the infection averaged 46.9 days and ranged from 13 to 92 days, demonstrating the slow-growing nature of this organism. 

An additional 53 patients developed corneal tunnel infiltrates by the same organism at the site of the incision. Once the source contaminant was discovered, new and unopened bottles from the hospital pharmacy also were found to harbor the bacteria. 

They write that the association of this outbreak with B. cepacia is of particular importance as products contaminated with this pathogen have caused nosocomial outbreaks in health care facilities. Due to the persistent nature of this organism, long periods of follow-up are needed.

Any “sterile” consumable can be a common link to these outbreaks, and we must always remain vigilant in order to make sure we keep these outbreaks to a minimum.

Discussion question: What steps can you take to help your surgical facility minimize endophthalmitis risks?