Burkholderia Postoperative Endophthalmitis and an Outbreak Including Bilateral Simultaneous Postoperative Endophthalmitis
Mike Yuan Chen1, Susan Ruyu Qi2, Jens Kratholm3 and Steve Arshinoff1,4*
1York Finch Eye Associates, Toronto, Ontario, Canada
2Department of Ophthalmology, Laval University, Quebec City, Canada
3Narvik Eye Clinic, Narvik, Norway
4Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
*Corresponding Author: Steve Arshinoff, York Finch Eye Associates, Toronto, Ontario, Canada.
December 24, 2021; Published: January 31, 2022
Purpose: To describe a single-center series of the first Burkholderia contaminans postoperative endophthalmitis (POE) cases and the first suspected Burkholderia cepacia complex (Bcc) bilateral simultaneous postoperative endophthalmitis (BSPOE) in the context of Burkholderia bacteria and systemic Burkholderia infections.
Setting: The Narvik Eye Clinic, Narvik, Norway.
Design: Retrospective study of all 5 unilaterally and one bilaterally infected patients, the surgical environment, Burkholderia bacteriology and the likely cause of the infections.
Methods: Meticulous review of the case series occurring during unusual winter weather in arctic Norway in January 2019, detailed examination of the surgical clinic, dismantled for this assessment, followed by detailed review of the biology of Bcc species and the infections it can cause.
Results: Six patients developed postoperative Bcc endophthalmitis within 4 months postoperatively, with one case suffering BSPOE. All cases, except one eye of the BSPOE patient, were vitreous-culture positive for B. contaminans. The Bcc strain was genetically identical to the ones later cultured from the surgical center’s ventilation system. All patients recovered visual acuity of 20/25 or better after aggressive treatment.
Conclusions: Bcc-induced postoperative endophthalmitis is rare and can occur if operating room ventilation is tampered with. It is challenging to treat with generally poor outcomes prior to the current series, in which all cases did well.
Keywords: Endophthalmitis; Postoperative Endophthalmitis; Bilateral Endophthalmitis; Bilateral Simultaneous Postoperative Endophthalmitis; Bilateral Postoperative Endophthalmitis; Operating Room Ventilation; Burkholderia; Burkholderia Endophthalmitis
- Malmin A., et al. “Twenty years of endophthalmitis: incidence, aetiology and clinical outcome”. Acta Ophthalmology 99 (2021): e62-e69.
- Nowak MS., et al. “Incidence and characteristics of endophthalmitis after cataract surgery in poland, during 2010-2015”. International Journal of Environmental Research and Public Health 16 (2019): 2188.
- Oh BL., et al. “Change in nationwide incidence of post-cataract surgery endophthalmitis: Korean cohort study from 2002 to 2013”. Ocular Immunology and Inflammation 27 (2019): 756-761.
- Brundrett A., et al. “Current strategies for prevention and treatment of postoperative endophthalmitis”. Current Ophthalmology Report 6 (201): 105-114.
- Teweldemedhin M., et al. “Bacterial 8profile of ocular infections: a systematic review”. BMC Ophthalmology 17 (2017): 212.
- Stevenson LJ., et al. “Gram-negative endophthalmitis: a prospective study examining the microbiology, clinical associations and visual outcomes following infection”. Clinical and Experimental Ophthalmology 48 (2020): 813-820.
- Chen MY., et al. “Bilateral simultaneous postoperative endophthalmitis (BSPOE): Review of cases reported over the past 50 years”. Journal of Cataract and Refractive Surgery (2021).
- Lind C., et al. “Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery”. Journal of Ophthalmic Inflammation and Infection 11 (2021): 12.
- Tavares M., et al. “Burkholderia cepacia complex bacteria: a feared contamination risk in water-based pharmaceutical products”. Clinical Microbiology Review 33 (2020): e00139-19.
- Dworkin M., et al. “The Prokaryotes”. Volume 5 Proteobacteria: Alpha and Beta Subclasses (3rd ed.). Springer (2006): 15-18.
- Burkholder WH. "Sour skin, a bacterial rot of onion bulbs”. Phytopathology 40 (1950): 115-117.
- Master ER and Mohn WW. “Psychrotolerant bacteria isolated from arctic soil that degrade polychlorinated biphenyls at low temperatures”. Applied and Environmental Microbiology 64 (1998): 4823-4829.
- Ahn Y., et al. “Oligotrophic media compared with a tryptic soy agar or broth for the recovery of Burkholderia cepacia complex from different storage semperatures and culture conditions”. Journal of Microbiolog and Biotechnology 29 (2019): 1495-1505.
- Fakruddin M., et al. “Viable but nonculturable bacteria: food safety and public health perspective”. ISRN Microbiology 2013 (2013): 703813.
- Li L., et al. “The importance of the viable but non-culturable state in human bacterial pathogens”. Frontiers in Microbiology 5 (2014): 258.
- Rhodes KA and Schweizer HP. “Antibiotic Resistance in Burkholderia Species”. Drug Resistant Update 176 (2016): 82-90.
- Spencer HK., et al. “An overview of the treatment of less common non–lactose-fermenting gram-negative bacteria”. Pharmacotherapy 40 (2020): 936-951.
- Levy JH and Katz HR. “Pseudomonas cepacia keratitis”. Cornea 8 (1989): 67-71.
- Del Piero E., et al. “Pseudomonas cepacia endophthalmitis”. Annals of Ophthalmology 17 (1985): 753-756.
- Deka A., et al. “Burkholderia cepacia endophthalmitis: an unusual presentation”. Journal of Ophthalmic and Vision Research 13 (2018): 504-507.
- Eser I., et al. “Two cases of Burkholderia cepacia endophthalmitis”. British Journal of Ophthalmology 90 (2006): 1211.
- Pathengay A., et al. “Recurrent endophthalmitis caused by Burkholderia cepacian”. Eye (Lond) 19 (2005): 358-359.
- Mitra S., et al. “Unusual microbiological presentations in polymicrobial post-operative endophthalmitis and their clinical correlations”. International Ophthalmology 39 (2019): 2143-2148.
- Lalitha P., et al. “Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops”. British Journal of Ophthalmology 98 (2014): 1498-5102.
- Sunenshine R., et al. “An outbreak of postoperative gram-negative bacterial endophthalmitis associated with contaminated trypan blue ophthalmic solution”. Clinical Infectious Diseases 48 (2009): 1580-1583.
- Sachdeva V., et al. “Burkholderia cepacia endophthalmitis: clinico-microbiologic profile and outcomes”. Retina 31 (2011): 1801-1805.
- Örnek K., et al. “Burkholderia cepacia keratitis with endophthalmitis”. Journal of Medical Microbiology 58 (2009): 1517-1518.
- Spilker T., et al. “Outbreak of Burkholderia contaminans endophthalmitis traced to a clinic ventilation system”. Infection Control and Hospital Epidemiology (2021): 1-3.
- ESCRS Endophthalmitis Study group. “Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors”. Journal of Cataract and Refractive Surgery 33 (2007): 978-988.
- Osher RH., et al. “Purifying the air over the operating field and reducing the possibility of airborne contamination with a new mobile laminar airflow device”. Journal of Cataract and Refractive Surgery (2021).
- Sabherwal S., et al. “Are high-efficiency particulate air (HEPA) filters and laminar air flow necessary in operating rooms to control acute post-operative endophthalmitis?” Indian Journal of Ophthalmology 68 (2020): 1120-1125.