Chronic Post-Operative Endophthalmitis Caused by an Unusual Strain-Rhizobium Radiobacter

罕見菌種導致之慢性術後眼內炎－病例報告

楊怡君(Yi-Chun Yang) ； 李安斐(An-Fei Li) ； 林佩玉(Pei-Yu Lin) ； 李鳳利(Fenq-Lih Lee)

《中華民國眼科醫學會雜誌》 48卷2期 (2009/06) Pp. 200-204

https://doi.org/10.30048/ACTASOS.200906.0013

摘要

目的：報告一例白內障術後由罕見菌種導致的慢性術後眼內炎。
方法：病例報告。
結果：一47歲男性於右眼白內障術後兩個月因視力模糊診斷為葡萄膜炎，前後治療近一年症狀仍持續故轉而求診，眼科理學檢查高度懷疑為右眼眼內炎，收集前房液與玻璃體培養後，給予玻璃體內注射廣效性抗生素與amphotericin B，針對Propionbacterium acne的PCR結果為陰性。因治療無效故施行玻璃體切除術，培養結果顯示菌種為Rhizobinm rediobacter，針對抗生素敏感度試驗結果，此菌種對於Ceftazidime，Ciprofloxacin皆呈現抗藥性，給予病人Moxifloxacin眼藥水，症狀有逐漸緩解。
結論：在處理眼內感染上，對於Ciprotloxacin呈現抗藥性之菌株，就眼科醫師而言將是一個新的挑戰。

並列摘要

Purpose: To report a case of chronic endophthalmitis caused by Rhizobium radiobacter after cataract surgery.
Methods: interventional case report.
Results: This 47-year-old male received right eye cataract surgery in Mar. 2006. Uveitis OD was impressed since May 2006. Due to poor response to medical treatment, he was referred to our ophthalmology clinic in Apr 2007. The best correct visual acuity of his right eye was counting finger. Slit lamp exam showed anterior chamber with 3+ cell. B-scan showed vitreous opacity. Initial vitreous and aqueous tapping showed Viridians Streptococcus and Candida species, thus intravitreous injection of amphotericin B, Vancomycin and Ceftazidime was given. Polymerase chain reaction of Propionbacterium acne was negative. Therefore, pars plana vitrectomy was needed for lack of improvement. Culture of undiluted vitreous yielded Rhizobium rediobacter resistant to Ceftazidime, Ciprofloxacin and Gentamycin but susceptible to Amikacin. Topical Amikacin eye drop was intolerable and intravitreous injection of Amikacin has an unpredictable risk of macular infarction. After treatment with topical and systemic Moxifloxacin, symptoms got improved in 2 weeks and ultimately resolved.
Conclusion: Ciprofloxacin resistant bacteria may be the challenge in managing intraocular infection.

並列關鍵字

chronic endophthalmitis ； Rhizobium radiobacter