Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis: Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm

Jia-Horung Hung; Wen-Chien Ko; Chau-Yin Chen; Sheng-Hsiang Lin; Cheng-Lin Wu; Sheng-Min Hsu; Yu-Ti Teng; Shih-Hao Wang; Sung-Huei Tseng; Fu-Chin Huang; Chun-Chieh Lai; Ching-Lung Chen; Chien-Hsiung Lai; Po-Lin Chen; Evelyn Jou-Chen Huang

Journal of Microbiology, Immunology and Infection (Oct 2020)

Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis: Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm

Jia-Horung Hung,
Wen-Chien Ko,
Chau-Yin Chen,
Sheng-Hsiang Lin,
Cheng-Lin Wu,
Sheng-Min Hsu,
Yu-Ti Teng,
Shih-Hao Wang,
Sung-Huei Tseng,
Fu-Chin Huang,
Chun-Chieh Lai,
Ching-Lung Chen,
Chien-Hsiung Lai,
Po-Lin Chen,
Evelyn Jou-Chen Huang

Affiliations

Jia-Horung Hung: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Wen-Chien Ko: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Diagnostic Microbiology and Antimicrobial Resistance Laboratory, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Chau-Yin Chen: Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
Sheng-Hsiang Lin: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Cheng-Lin Wu: Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Sheng-Min Hsu: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Yu-Ti Teng: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Shih-Hao Wang: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Sung-Huei Tseng: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Fu-Chin Huang: Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Chun-Chieh Lai: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Ching-Lung Chen: Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Chien-Hsiung Lai: Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
Po-Lin Chen: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Diagnostic Microbiology and Antimicrobial Resistance Laboratory, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Taiwan; Corresponding author. Department of Microbiology and Immunology. College of Medicine, National Cheng Kung University, 138, Sheng-Li Rd., Tainan, Taiwan. Fax: +886 6 2766177.
Evelyn Jou-Chen Huang: Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Corresponding author. Department of Ophthalmology, Taipei Medical University Hospital, No.250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan.

Journal volume & issue: Vol. 53, no. 5
pp. 766 – 777

Abstract

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Purpose: Postoperative endophthalmitis caused by nontuberculous mycobacterium is a rare but devastating complication after intraocular surgery. However, optimal treatment strategies remain undetermined in view of its rarity. Methods: We investigated the cases of culture-proven postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis in southern Taiwan, focusing on clinical manifestations and microbiological study, and aimed to describe clinical staging and to propose a therapeutic modality for this disease. Results: Twelve cases, including two published cases, were treated in two medical centers in southern Taiwan between Aug. 2011 and Dec. 2016, and all ever received cataract surgery at one clinic. Their disease courses could be categorized into four distinct stages, i.e., the initial, quiescent, recurrent, and end stage, and some cases experienced 1–4 cycles of quiescent-recurrent stages. Although all eyes ended up with phthisis or were eviscerated, the affected eyes receiving pars plana vitrectomy (PPV) tended to become quiescent and survived longer than those without PPV (adjusted hazard ratio: 13.9, p < 0.05). Eight isolates of eight patients were available for microbiological study. All isolates were susceptible to amikacin, and inducible clarithromycin resistance was observed in 100% of isolates. Conclusion: Despite the preservation of vision in postoperative M. abscessus endophthalmitis remained a challenge, a stage-based approach is proposed, which may facilitate decision-makings for the future study.

Published in Journal of Microbiology, Immunology and Infection

ISSN: 1684-1182 (Print)
Publisher: Elsevier
Country of publisher: Hong Kong
LCC subjects: Science: Microbiology
Website: https://www.sciencedirect.com/journal/journal-of-microbiology-immunology-and-infection

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