TY - JOUR
T1 - Endophthalmitis Caused by Nontuberculous Mycobacterium
T2 - Clinical Features, Antimicrobial Susceptibilities, and Treatment Outcomes
AU - Shah, Milan
AU - Relhan, Nidhi
AU - Kuriyan, Ajay E.
AU - Davis, Janet L.
AU - Albini, Thomas A.
AU - Pathengay, Avinash
AU - Miller, Darlene
AU - Flynn, Harry W.
N1 - Funding Information:
Funding/Support: The authors acknowledge support from the National Institute of Health (NIH) Center Core Grant P30EY014801 (Bethesda, Maryland), Research to Prevent Blindness Unrestricted Grant (New York, New York), and the Department of Defense (DOD Grant #W81XWH-09-1-0675) (Washington, DC). Financial disclosures: Thomas A. Albini: consulting honoraria from Bausch & Lomb, Allergan, Thrombogenics, and Eleven Biotherapeutics; Ajay E. Kuriyan: grant funding from Bayer Pharmaceuticals. The following authors have no financial disclosures: Milan Shah, Nidhi Relhan, Janet L. Davis, Avinash Pathengay, Darlene Miller, and Harry W. Flynn, Jr. All authors attest that they meet the current ICMJE criteria for authorship.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Purpose To report the clinical features, antibiotic susceptibilities and treatment outcomes in patients with endophthalmitis caused by nontuberculous mycobacterium. Design Noncomparative, consecutive case series. Methods Retrospective chart review between December 1990 and June 2014. Results 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. Conclusion 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.
AB - Purpose To report the clinical features, antibiotic susceptibilities and treatment outcomes in patients with endophthalmitis caused by nontuberculous mycobacterium. Design Noncomparative, consecutive case series. Methods Retrospective chart review between December 1990 and June 2014. Results 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. Conclusion 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.
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U2 - 10.1016/j.ajo.2016.03.035
DO - 10.1016/j.ajo.2016.03.035
M3 - Article
C2 - 27048999
AN - SCOPUS:84973879189
VL - 168
SP - 150
EP - 156
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
SN - 0002-9394
ER -