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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 26, Issue 6, Pages 330-332
Case Report

Exogenous Endophthalmitis Caused by Enterococcus casseliflavus: A Case Report and Discussion Regarding Treatment of Intraocular Infection with Vancomycin-Resistant Enterococci

Byron M Berenger,1,2 Shobhana Kulkarni,3,4 Brad J Hinz,5 and Sarah E Forgie MD1,6

1Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
2Alberta Provincial Laboratory for Public Health, University of Alberta, Edmonton, Alberta, Canada
3DynaLIFEDx Diagnostic Laboratory Services, University of Alberta, Edmonton, Alberta, Canada
4Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
5Department of Ophthamology, University of Alberta, Edmonton, Alberta, Canada
6Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Endophthalmitis caused by enterococci is rare, and cases involving vancomycin-resistant enterococci are even more so. Due to the poor bioavailability of many antibiotics in the vitreous chamber, special considerations are required when choosing antibiotics to treat these infections. The authors report the first case of exogenous endophthalmitis caused by Enterococcus casseliflavus via the unique mechanism of high-velocity water stream trauma from a toy water gun.

A previously healthy four-year old boy presented with endophthalmitis of the left eye after injury from a water gun. Empirical treatment for endophthalmitis was started on presentation to the ophthalmologist. After the identification of the pathogen and a review of the literature, the antibiotic regimen was changed to include intravitreal ampicillin and amikacin with systemic linezolid.

Endophthalmitis caused by E casseliflavus and other vancomycin-resistant enterococci are challenging to treat. Rapid identification of vancomycin-resistant enterococcal endophthalmitis is important to guide appropriate antibiotic therapy. Systemic linezolid achieves excellent intravitreal concentrations, and should be used in combination with intravitreal and topical antibiotics.