Endophthalmitis: A Rare but Devastating Metastatic Bacterial Complication of Hemodialysis Catheter-Related Sepsis

There are many infectious complications related to vascular access in patients undergoing maintenance hemodialysis. We report two cases of endophthalmitis as a metastatic infection associated with a tunneled catheter and a temporary dual lumen catheter. Both patients were diabetic. A 61-year-old female on maintenance hemodialysis by a jugular tunnelized catheter during the past year was receiving parenteral antibiotics for catheter salvage due to fever episodes in the last 3 months. She was admitted to the hospital presenting pain, proptosis, conjunctival hyperemia, corneal infiltrate, and visual acuity of no light perception (NLP). A 51-year-old male recently undergoing hemodialysis by a temporary dual lumen catheter presented fever. His catheter was removed, but he was admitted to the hospital presenting fever, decreased vision, edema, and pain in his left eye. On examination, eyelid edema, conjunctival hyperemia, purulent secretion, hypopyon in the pupils, and visual acuity of NLP were verified. A diagnosis of endogenous endophthalmitis was made in both patients on clinical grounds and computed tomography. Evisceration of the left eye was the first option of treatment for both patients due to poor vision. Cultures of the eviscerated ocular globes showed Staphylococcus hemolyticus and Staphylococcus aureus, respectively. After evisceration, both patients received treatment, had a good outcome, and were discharged to continue their hemodialysis program. Metastatic bacterial endophthalmitis is a rare complication of dialysis catheter-related bacteremia. When suspected, urgent ophthalmologic evaluation and treatment are needed to reduce the risk of losing vision in the affected eye.

Epidemiologic surveillance of postoperative endophthalmitis in a specialized ophthalmologic center in Sao Paulo, Brazil

This article describes a postoperative endophthalmitis (POE) surveillance system in place in a specialized ophthalmologic center in Sao Paulo, Brazil. The study involved a review of medical records from 2004-2009, during which a total of 31,999 intraocular surgeries were performed. Nineteen of these cases fulfilled the criteria for POE, for an infection rate of 0.06%. The main etiologic agent causing POE was Pseudomonas aeruginosa, identified in 42.1% of the cases (8/19). Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Viral contamination during sequential phacoemulsification surgeries in an experimental model

Purpose: To determine the incidence of Piry virus contamination among surgical instruments used with disposable accessories for phacoemulsification during sequential surgeries. Methods: An experimental model was created with 4 pigs' eyes that were contaminated with Piry virus and 4 pigs' eyes that were not contaminated. Phacoemulsification was performed on the eyes, alternating between the contaminated and non-contaminated eyes. From one surgery to another, the operating fields, gloves, scalpel, tweezers, needles, syringes, tips and bag collector from the phacoemulsification machine were exchanged; only the hand piece and the irrigation and aspiration systems were maintained. Results: In the collector bag, three samples from the contaminated eyes (3/4) were positive, and two samples from the non-contaminated (2/4) eyes were also positive; at the tip, one sample from the contaminated eyes (1/4) and two samples of the noncontaminated eyes (2/4) yielded positive results. In the irrigation system, one sample from a non-contaminated eye (1/4) was positive, and in the aspiration system, two samples from contaminated eyes (2/4) and two samples from non-contaminated eyes (2/4) were positive. In the gloves, the samples were positive in two samples from the non-contaminated eyes (2/4) and in two samples from the contaminated eyes (2/4). In the scalpel samples, three contaminated eyes (3/4) and none of the non-contaminated eyes (0/4) were positive; finally, two samples from the anterior chambers of the non-contaminated eyes gathered after surgery were positive. Conclusions: In two non-contaminated eyes, the presence of genetic material was detected after phacoemulsification surgery, demonstrating that the transmission of the genetic material of the Piry virus occurred at some point during the surgery on these non-contaminated eyes when the hand piece and irrigation and aspiration systems were reused between surgeries.

EVALUATION OF MICROBIAL GROWTH ON SINGLE-USE VITRECTOMY PROBES REPROCESSED IN HEALTHCARE PRACTICE

The aim of this study was to evaluate the microbial growth on single-use vitrectomy probes reprocessed in healthcare practice. We investigated nine vitrectomy probes that had been reused and reprocessed using different methods. The samples were sectioned, individually, in portions of 3.5 cm, totaling 979 sampling units (extensions, connectors and vitrectomy cutters), which were inoculated in culture medium and incubated at 37 C for 14 days. The results showed microbial growth on 57 (5.8%) sample units, 25 of which had been sterilized using ethylene oxide, 16 by hydrogen peroxide plasma, and 16 by low-temperature steam and formaldehyde. Seventeen microbial species were identified. The most prevalent were: Micrococcus spp., coagulase-negative Staphylococcus, Pseudomonas spp., and Bacillus subtilis. The reuse of single-use vitrectomy probes was shown to be unsafe, therefore this practice is not recommended.

Avaliação do crescimento microbiano em sondas de uso único para vitrectomia reprocessadas na prática assistencial

O objetivo deste estudo foi avaliar o crescimento microbiano em sondas para vitrectomia de uso único, reprocessadas na prática assistencial. Foram investigadas nove sondas reusadas e reprocessadas por diferentes métodos. As sondas foram segmentadas, individualmente, em porções de 3,5 cm, totalizando em 979 unidades amostrais (extensões, conectores e ponteiras) inoculadas em meio de cultura e incubadas a 37ºC, por 14 dias. Os resultados mostraram crescimento microbiano em 57 (5,8%) unidades amostrais, das quais, 25 foram esterilizadas por Óxido de Etileno, 16 por Plasma de Peróxido de Hidrogênio e 16 por Vapor à Baixa Temperatura e Formaldeído. Foram identificadas 17 espécies microbianas, sendo as mais prevalentes o Micrococcus spp., Staphylococcus coagulase negativa, Pseudomonas spp. e Bacillus subtilis. O reuso de sondas de uso único para vitrectomia não se mostrou seguro, portanto tal prática não é recomendada.