Clinical Features, Antimicrobial Susceptibilities, and Outcomes of Acute-Onset Exogenous Nocardia Endophthalmitis

Purpose: To describe the clinical features, antimicrobial susceptibilities, and treatment outcomes of acute-onset exogenous Nocardia endophthalmitis following non-cataract surgery. Methods: Two cases were retrospectively reviewed. Results: Two patients developed acute-onset exogenous endophthalmitis following non-cataract procedures and subsequently underwent multiple surgical interventions. The first patient developed a fulminant infection in the left eye following revision of a glaucoma drainage implant and ultimately progressed to no-light-perception vision, undergoing enucleation. The second patient developed endophthalmitis secondary to infectious scleritis in the right eye and had a best-corrected visual acuity of 5/200 at last follow-up. Microbiologic analysis identified Nocardia brasiliensis and Nocardia niwae. Both isolates demonstrated susceptibility to amikacin and sulfamethoxazole/trimethoprim, with variable susceptibility to β-lactams and fluoroquinolones. Conclusions: Acute-onset exogenous Nocardia endophthalmitis may occur after a variety of ophthalmologic procedures and is associated with a poor visual prognosis despite surgical intervention and targeted antimicrobial therapy. Amikacin and sulfamethoxazole/trimethoprim remain the preferred antimicrobial agents.