ENTEROBACTER-CLOACAE ENDOPHTHALMITIS - REPORT OF 4 CASES

Members of the genus Enterobacter are commensal organisms of the gastr ointestinal tract and are considered pathogenic only for patients,vith lowered resistance to infection (e.g., chronic infection, cancer, or diabetes mellitus) or those with impaired immunity (congenital, acquir ed, or impaired immunity secondary to therapy), We report on four case s of endophthalmitis caused by Enterobacter cloacae: two in patients w ith acute postoperative endophthalmitis, one in a patient with delayed bleb-related endophthalmitis, and one in a patient presenting with pr esumed posttraumatic endophthalmitis, Each patient presented with seve re disease many days after the onset of ocular symptoms, and two patie nts had systemic risk factors accounting for a reduced resistance to i nfection, Endophthalmitis caused by gram-negative bacilli is character ized by acute onset, rapid progression, and poor final visual outcome, Each of these patients was treated by a standard protocol with intrav itreal, systemic, and topical antibiotics and systemic steroids, Despi te treatment, the final visual outcomes for three of these patients wa s no perception of light, and that for one patient remained perception of hand movements only, In common with endophthalmitis caused by othe r gram-negative organisms, intraocular infection secondary to Enteroba cter cloacae infection is a devastating disease which, despite treatme nt, results in extensive ocular damage and severe visual loss, Since 1 966, only four cases of endophthalmitis secondary to infection with me mbers of this genus have been reported, This report presents four case s which occurred over a period of 14 months and, to the best of our kn owledge, the first case of bleb-related endophthalmitis secondary to E . cloacae infection.