Stenotrophomonas maltophilia endophthalmitis following cataract surgery: clinical and microbiological results

Jonathan S Chang, Harry W Flynn Jr, Darlene Miller, William E Smiddy

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

Background: Stenotrophomonas maltophilia is a Gram-negative organism known to cause opportunistic infections. It is a rare source of endophthalmitis, often in the setting of trauma, but has been reported following cataract extraction. The purpose of this study was to evaluate antimicrobial sensitivities, clinical characteristics, and treatment outcomes in patients with endophthalmitis caused by S. maltophilia following cataract extraction.
Methods: A retrospective case review of records from January 1, 1990 to June 30, 2010 was performed at the Bascom Palmer Eye Institute.
Results: Eight cases of S. maltophilia endophthalmitis were identified following cataract surgery. Initial visual acuity ranged from 20/200 to light perception. Time to diagnosis with cultures was 2–118 days. Patients received either intravitreal tap and inject (n = 5) or pars plana vitrectomy with intravitreal antibiotic injections (n = 3). All patients had vitreous or anterior chamber cultures positive for S. maltophilia. Seven of seven isolates tested were found to be sensitive to ceftazidime. Seven of eight isolates were sensitive to polymyxin B, six of eight isolates were sensitive to amikacin, and five of the seven isolates tested were sensitive to ciprofloxacin. Two of four tested isolates were sensitive to trimethoprim-sulbactam. All eight isolates were resistant to gentamicin and seven of the seven tested isolates were resistant to imipenem. All patients received intravitreal ceftazidime as part of the initial treatment regimen. Final visual acuity ranged from 20/25 to 4/200.
Conclusion: S. maltophilia endophthalmitis is a rare source of endophthalmitis following cataract surgery. A case series of eight independent patients is reported, along with antibiotic resistance profiles and clinical outcomes. Isolates showed sensitivity to ceftazidime, amikacin, and polymyxin, with variable sensitivity to other antibiotics, therefore differing from previous reports.

Keywords: endophthalmitis, Stenotrophomonas maltophilia, cataract