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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalJournal of Microbiology, Immunology and Infection
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Endophthalmitis
Temazepam
Vitrectomy
Taiwan
Nontuberculous Mycobacteria
Clarithromycin
Amikacin
Cataract
Decision Making
Therapeutics

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis: Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm",
abstract = "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.",
author = "Jia-Horung Hung and Wen-Chien Ko and Chen, {Chau Yin} and Sheng-Hsiang Lin and Wu, {Cheng Lin} and Sheng-Min Hsu and Teng, {Yu Ti} and Wang, {Shih Hao} and Tseng, {Sung Huei} and Fu-Chin Huang and Lai, {Chun Chieh} and Chen, {Ching Lung} and Lai, {Chien Hsiung} and Po-Lin Chen and {Jou-Chen Huang}, Evelyn",
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Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis : Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm. / Hung, Jia-Horung; Ko, Wen-Chien; Chen, Chau Yin; Lin, Sheng-Hsiang; Wu, Cheng Lin; Hsu, Sheng-Min; Teng, Yu Ti; Wang, Shih Hao; Tseng, Sung Huei; Huang, Fu-Chin; Lai, Chun Chieh; Chen, Ching Lung; Lai, Chien Hsiung; Chen, Po-Lin; Jou-Chen Huang, Evelyn.

In: Journal of Microbiology, Immunology and Infection, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis

T2 - Clinical analysis of 12 clustered adults and a proposed therapeutic algorithm

AU - Hung, Jia-Horung

AU - Ko, Wen-Chien

AU - Chen, Chau Yin

AU - Lin, Sheng-Hsiang

AU - Wu, Cheng Lin

AU - Hsu, Sheng-Min

AU - Teng, Yu Ti

AU - Wang, Shih Hao

AU - Tseng, Sung Huei

AU - Huang, Fu-Chin

AU - Lai, Chun Chieh

AU - Chen, Ching Lung

AU - Lai, Chien Hsiung

AU - Chen, Po-Lin

AU - Jou-Chen Huang, Evelyn

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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