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Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular Infection Report.

Velez-Montoya R, Rascón-Vargas D, Mieler WF, Fromow-Guerra J, Morales-Cantón V - J Ophthalmol (2010)

Bottom Line: Results.Conclusion.While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.

View Article: PubMed Central - PubMed

Affiliation: Retina Department, Associacition to prevent blindness in México IAP, México City, Mexico.

ABSTRACT
Purpose. To describe the clinical characteristics, diagnosis, and treatment with intravitreal ampicillin sodium of a postoperative endophthalmitis case due to Streptococcus uberis; an environmental pathogen commonly seen in mastitis cases of lactating cows. Methods. Case Report. A 52-year-old, Hispanic diabetic patient who suddenly developed severe pain and severe loss of vision, following vitrectomy. Results. The patient was diagnosed with postoperative endophthalmitis secondary to a highly resistant strain of Streptococcus uberis that did not respond to intravitreal antibiotics. He was treated with an air-fluid interchange, anterior chamber washout, intravitreal ampicillin sodium (5 mg/0.1 mL), and silicon oil tamponade (5000 ck). The eye was anatomically stabilized, though there was no functional recovery. Conclusion. Streptococcus uberis is an uncommon pathogen to the human eye, which has unique features that help the strain in developing resistance to antibiotics. While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.

No MeSH data available.


Related in: MedlinePlus

Patient's clinical evolution: ((a) and (c)) previous air-fluid interchange and intravitreal ampicillin sodium; the anterior segment biomicroscopy showed severe conjunctival hyperemia, severe cellularity, and Hypopyon with a fibrin clot on the surface of the intraocular lens. The details of the retina cannot be observed due to significant posterior opacities. However, the optic nerve seems to be extremely pale with severe attenuation of the blood vessels. ((b) and (d)) Four weeks after second surgery; anterior segment biomicroscopy showed an improvement in conjunctival hyperemia (mild), with disappearance of Hypopyon and fibrin cloth, and the retina showed extensive areas of photocoagulation (first surgery), severe pallor of the optic nerve, bloodless vessels, and vitreous cavity filled with silicon oil.
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Related In: Results  -  Collection


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fig2: Patient's clinical evolution: ((a) and (c)) previous air-fluid interchange and intravitreal ampicillin sodium; the anterior segment biomicroscopy showed severe conjunctival hyperemia, severe cellularity, and Hypopyon with a fibrin clot on the surface of the intraocular lens. The details of the retina cannot be observed due to significant posterior opacities. However, the optic nerve seems to be extremely pale with severe attenuation of the blood vessels. ((b) and (d)) Four weeks after second surgery; anterior segment biomicroscopy showed an improvement in conjunctival hyperemia (mild), with disappearance of Hypopyon and fibrin cloth, and the retina showed extensive areas of photocoagulation (first surgery), severe pallor of the optic nerve, bloodless vessels, and vitreous cavity filled with silicon oil.

Mentions: The next day, the patient reported decreased pain, and on examination the vision remained no light perception, though there was no evidence of hypopyon and only mild conjunctival hyperemia. The patient remained hospitalized for the next three days, and during that time ampicillin sodium was administered intravenously, at adjusted doses of 1000 mg bid according to creatinine clearance. After discharge, the patient continued treatment with maintenance doses of intramuscular ampicillin sodium for two weeks. The patient continued to improve. Four weeks later, the integrity of the eye was preserved but the vision remained no light perception (Figure 2).


Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis: Streptococcus uberis First Human Intraocular Infection Report.

Velez-Montoya R, Rascón-Vargas D, Mieler WF, Fromow-Guerra J, Morales-Cantón V - J Ophthalmol (2010)

Patient's clinical evolution: ((a) and (c)) previous air-fluid interchange and intravitreal ampicillin sodium; the anterior segment biomicroscopy showed severe conjunctival hyperemia, severe cellularity, and Hypopyon with a fibrin clot on the surface of the intraocular lens. The details of the retina cannot be observed due to significant posterior opacities. However, the optic nerve seems to be extremely pale with severe attenuation of the blood vessels. ((b) and (d)) Four weeks after second surgery; anterior segment biomicroscopy showed an improvement in conjunctival hyperemia (mild), with disappearance of Hypopyon and fibrin cloth, and the retina showed extensive areas of photocoagulation (first surgery), severe pallor of the optic nerve, bloodless vessels, and vitreous cavity filled with silicon oil.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2913728&req=5

fig2: Patient's clinical evolution: ((a) and (c)) previous air-fluid interchange and intravitreal ampicillin sodium; the anterior segment biomicroscopy showed severe conjunctival hyperemia, severe cellularity, and Hypopyon with a fibrin clot on the surface of the intraocular lens. The details of the retina cannot be observed due to significant posterior opacities. However, the optic nerve seems to be extremely pale with severe attenuation of the blood vessels. ((b) and (d)) Four weeks after second surgery; anterior segment biomicroscopy showed an improvement in conjunctival hyperemia (mild), with disappearance of Hypopyon and fibrin cloth, and the retina showed extensive areas of photocoagulation (first surgery), severe pallor of the optic nerve, bloodless vessels, and vitreous cavity filled with silicon oil.
Mentions: The next day, the patient reported decreased pain, and on examination the vision remained no light perception, though there was no evidence of hypopyon and only mild conjunctival hyperemia. The patient remained hospitalized for the next three days, and during that time ampicillin sodium was administered intravenously, at adjusted doses of 1000 mg bid according to creatinine clearance. After discharge, the patient continued treatment with maintenance doses of intramuscular ampicillin sodium for two weeks. The patient continued to improve. Four weeks later, the integrity of the eye was preserved but the vision remained no light perception (Figure 2).

Bottom Line: Results.Conclusion.While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.

View Article: PubMed Central - PubMed

Affiliation: Retina Department, Associacition to prevent blindness in México IAP, México City, Mexico.

ABSTRACT
Purpose. To describe the clinical characteristics, diagnosis, and treatment with intravitreal ampicillin sodium of a postoperative endophthalmitis case due to Streptococcus uberis; an environmental pathogen commonly seen in mastitis cases of lactating cows. Methods. Case Report. A 52-year-old, Hispanic diabetic patient who suddenly developed severe pain and severe loss of vision, following vitrectomy. Results. The patient was diagnosed with postoperative endophthalmitis secondary to a highly resistant strain of Streptococcus uberis that did not respond to intravitreal antibiotics. He was treated with an air-fluid interchange, anterior chamber washout, intravitreal ampicillin sodium (5 mg/0.1 mL), and silicon oil tamponade (5000 ck). The eye was anatomically stabilized, though there was no functional recovery. Conclusion. Streptococcus uberis is an uncommon pathogen to the human eye, which has unique features that help the strain in developing resistance to antibiotics. While treatment with intravitreal ampicillin is feasible, there are still concerns about its possible toxicity.

No MeSH data available.


Related in: MedlinePlus