Stenotrophomonas maltophilia induzierte Endophthalmitis
Stenotrophomonas maltophilia, a micro-organism which colonises plastic material was isolated in only 10 known cases of postcataract surgery endophthalmitis (PE) world-wide. We present characteristics, treatment and outcome in 26 cases of PE caused by S. maltophilia contaminated rinsing solution used during cataract surgery. Methods: 21/26 patients (81%) required pars plana vitrectomy and were treated with intravitreal, topical, subconjunctival and systemic antibiotics covering to the most likely pathogens. 2 days after surgery identification of S. maltophilia allowed change of therapy to trimethoprim/sulfamethoxazol (TMP-SMX) 960mg bid i.v. and Ciprofloxacin 400mg -750mg bid p.o. for 10 days and TMP-SMX 960mg bid p.o. and Ciprofloxacin 250mg or 500mg bid p.o. for further 20 days, complemented with i.v. Fluorcortolone and topical treatment. Vision was examined before and during, 1 and 6 months after acute PE. Results: Before cataract surgery visual acuity was <0,3 in 12/26 patients (46%), during acute infection in 20/26 (77%), after 1 month in 6/26 patients (23%) and after 6 months in 3/24 patients (11,5%) (p<0,001). Within 6 months after PE, there were 1 retinal ablation, 2 intra-retinal bleedings and 2 relapses of infection with isolation of S. maltophilia in 1 case. Conclusions: Antibiotic treatment of PE should initially cover the most likely pathogens. Intravenous antibiotic therapy should include substances that penetrate well into the eye structures. Resistance testing allows change of therapy regimen early in the course of infection. Systemic treatment in S. maltophilia infection should be continued for 4 weeks after PE to diminish the risk of persistent pathogens.
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