meropenem and Endophthalmitis

To describe the first known case of Bacteroides spp. related blebitis, keratitis, and endophthalmitis following uncomplicated trabeculectomy.. This was a case report and literature review.. A 63-year-old immunocompetent white male underwent uncomplicated trabeculectomy of his right eye. Two weeks later, a blebitis with adjacent keratitis was diagnosed, progressing over several days to endophthalmitis despite hourly topical fortified antibiotic therapy. Although gram stain and culture of the bleb surface, a conjunctival suture, the aqueous humor, and the vitreous were negative, topical real-time quantitative polymerase chain reaction testing disclosed the presence of Bacteroides spp. Following treatment with topical and intravitreal clindamycin and intravenous meropenem, all clinical evidence of infection resolved. Best spectacle-corrected visual acuity improved to 20/25 (0.8) subsequent to combined cataract extraction, intraocular lens implantation, and pars plana vitrectomy for persistent vitreous debris.. Bacteroides may be a rare cause of postoperative blebitis, keratitis, and endophthalmitis. A favorable outcome may be attained, provided that an accurate diagnosis and effective treatment can be provided, which may be facilitated by real-time quantitative polymerase chain reaction in select cases.

Topics: Administration, Ophthalmic; Anti-Bacterial Agents; Bacteroides; Bacteroides Infections; Clindamycin; Corneal Ulcer; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Glaucoma, Open-Angle; Humans; Injections, Intravenous; Intravitreal Injections; Male; Meropenem; Middle Aged; Real-Time Polymerase Chain Reaction; Trabeculectomy

To describe the first case of endophthalmitis caused by. An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant.. Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade.

Topics: Administration, Ophthalmic; Aged, 80 and over; Anti-Bacterial Agents; Cataract Extraction; Ceftazidime; Endophthalmitis; Eye Infections, Bacterial; Glaucoma Drainage Implants; Glaucoma, Open-Angle; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Intraocular Pressure; Intravitreal Injections; Male; Meropenem; Postoperative Complications; Reoperation; Sphingobacterium; Stents; Tonometry, Ocular; Visual Acuity; Vitrectomy; Vitreous Body

Topics: Anti-Bacterial Agents; Ceftazidime; Child; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Feces; Humans; Immunocompetence; Male; Meropenem; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi B; Thienamycins; Vancomycin; Visual Acuity; Vitreous Body

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Meropenem; Nocardia; Nocardia Infections; RNA, Bacterial; RNA, Ribosomal, 16S; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to evaluate the antibiotic treatment of postoperative endophthalmitis with combined systemic meropenem and linezolid.. A retrospective analysis of endophthalmitis treated with systemic meropenem and linezolid compared to conventional systemic antibiotics by evaluation of outcome and adverse effects was carried out.. 26 patients with unilateral postoperative endophthalmitis with a systemic combination regimen of meropenem (2 g TID, mean duration of treatment 5.5 days) and linezolid (600 mg BID, mean duration of treatment 8.9 days) (group 1, mean follow-up time 140 days) were included in this study and compared to 45 postoperative endophthalmitis patients treated with conventional systemic antibiotics (group 2; mean follow-up time 320 days). In group 1, 69.2 % of eyes additionally received intravitreal amikacin and vancomycin (vs. 24.4 % in group 2; p < 0.001), in 92.3 % pars plana vitrectomy was performed (vs. 68.9 % in group 2, p = 0.047). Mean best corrected visual acuity improved from a baseline of 1.76 logMar for group 1 and 1.83 logMar for group 2 to 0.91 logMar (p = 0.0001) and 0.90 logMar (p < 0.0001), respectively, at the end of the follow-up, revealing no significant differences between the two groups at any time point (p > 0.05). Ocular complications were observed in 34.6 % of eyes in group 1 (vs. 37.8 % in group 2; p > 0.05). Adverse drug effects occurred significantly more frequently in group 1 (26.9 % vs. 4.4 % p = 0.02).. In spite of the reported better penetration through the blood-ocular barrier and the broader antibacterial spectrum of meropenem and linezolid, no benefit in outcome was found in the present study. In contrast, adverse effects and costs of the combination regimen were significantly higher.

Topics: Acetamides; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Drug Combinations; Endophthalmitis; Female; Humans; Linezolid; Male; Meropenem; Ophthalmologic Surgical Procedures; Oxazolidinones; Retrospective Studies; Thienamycins; Treatment Outcome