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Case Reports and Small Case Series
April 2000

Xanthomonas maltophilia Endophthalmitis After Cataract Surgery

Arch Ophthalmol. 2000;118(4):572-575. doi:

Xanthomonas maltophilia, previously known as Pseudomonas maltophilia and Stenotrophomonas maltophilia, is a gram-negative motile bacillus that can be isolated from human, animal, and environmental sources.1 It may cause potentially life-threatening opportunistic systemic infections.1,2 Most isolates demonstrate multidrug resistance, making it a highly virulent organism. Postoperative endophthalmitis caused by X maltophilia is rare. To date, only 2 case reports have been published.3,4 We describe 4 additional patients with postoperative X maltophilia endophthalmitis treated between January 1, 1996, and March 31, 1999, at the Bascom Palmer Eye Institute, Miami, Fla (Table 1).

An 80-year-old woman was evaluated for increasing pain and decreased vision in the left eye, 2 weeks after uneventful clear-corneal phacoemulsification and posterior chamber intraocular lens (IOL) insertion. Her medical history was unremarkable. Visual acuity in the affected eye was hand movements. Clinical findings included a 5% hypopyon and marked vitritis. Vitreous tap was performed through the pars plana, and the patient was given intravitreal injections of ceftazidime, 2.25 mg; vancomycin hydrochloride, 1.0 mg; and dexamethasone sodium phosphate, 0.4 mg. On the first day after the initial treatment, a combined regimen was started with topical fortified ceftazidime, vancomycin, and 1% prednisolone acetate, every hour, and 1% atropine sulfate, 3 times daily. No systemic antibiotic therapy was used. Gram stain of the vitreous aspirate revealed many neutrophils, but no organisms were identified. Three days later, X maltophilia was isolated from the culture that was resistant to ceftazidime but sensitive to amikacin sulfate (Table 2). However, her clinical condition continued to improve, with resolution of the hypopyon; visual acuity returned to 20/50 OS. A small amount of retained lens cortex was noted at the 6-o'clock position. Gradual tapering of topical medications was begun.