Pantoea agglomerans endophthalmitis: clinical features and outcomes.

PURPOSE: To determine the clinical profile and outcomes of patients with Pantoea agglomerans endophthalmitis as seen at a tertiary eye care center in India. METHODS: Retrospective observational case series. Data collected included demographics, history, the initial and final corrected distance visual acuity, details of the ocular and systemic examination, surgeries performed, and the final anatomical outcome. The final corrected distance visual acuity and the anatomical outcome were the outcome measures. RESULTS: Four patients had traumatic endophthalmitis; the fifth developed endophthalmitis after cataract surgery. All patients were men with a mean age of 34.24 ± 23.34 years. Three patients had corneal laceration and traumatic cataract. All patients underwent vitreous sampling with intraocular antibiotic injection with or without lensectomy and corneal wound repair. The visual acuity at presentation ranged from hand motion to perception of light. One patient ended up with phthisis in the affected eye. One patient developed postoperative retinal detachment and underwent successful surgery. The final visual acuity ranged from 20/25 to no light perception. CONCLUSION: P. agglomerans is a likely source of infection in traumatic and postoperative cases. Though variable, it appears sensitive to common antibiotics. The visual and anatomical prognosis seems fair in most cases. Special care needs to be taken to ensure the organism is not missed, given the rarity of the condition and the isolation techniques required.

The microbiological spectrum and antibiotic sensitivity profile of extubated silicone stents following dacryocystorhinostomy.

PURPOSE: We aim to report the microbiological spectrum of organisms cultured from extubated silicone stents after a dacryocystorhinostomy and their antibiotic sensitivity patterns. STUDY DESIGN: Prospective interventional study. METHODS: 50 silicone stents of 50 consecutive patients who underwent either external or endonasal dacryocystorhinostomy were enrolled for the study. All the stents were retrieved under endoscopic guidance from the nasal cavity at 3 months following surgery. All the tubes were immediately inoculated onto blood agar, chocolate agar, brain-heart infusion broth, Saboraud's dextrose agar and potato dextrose agar. Data collected and analyzed include demographics, diagnosis, type of dacryocystorhinostomy and the microbiological profile. The culture results, organisms isolated and their antibiotic sensitivity were studied. RESULTS: The mean age of patients at the time of dacyrocystorhinostomy was 34.4 years. Bacterial growth was noted in 88% (44/50) of all the stents cultured, whereas 60% (30/50) grew fungi and 6% (3/50) showed sterile cultures. 48% (24/50) of the stents showed mixed bacterial and fungal isolates. Among the fungal isolates, Aspergillus species accounted for 66.6% (20/30) followed by Fusarium species, which were seen in 26.6% (8/30). Among the bacterial isolates, gram negative organisms were the most common seen in 54.5% (24/44) and the commonest species isolated was Pseudomonas aeruginosa from 27% (12/44) of the stents. Staphylococcus aureus was the commonest gram positive isolate accounting for 18% of all the bacterial isolates. Gram positive organisms were commonly sensitive to cephalosporins and vancomycin whereas gram negative organisms were sensitive to quinolones and aminoglycosides. The surgical success rate was 96% (48/50). CONCLUSIONS: Fungal isolates were cultured from significant number of stents retrieved following dacryocystorhinostomy. Gram negative organisms are more common as compared to the gram positive. The organisms isolated were not found to influence the success of dacryocystorhinostomy.