Adverse Occurrence type:
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
There were 4 cases of postop endophthalmitis within one week, 3 from Enterococcus faecalis, one from Torulopsis glabrata. Ten of 11 donor rim cultures were positive but only 4 infections resulted. 2 of 4 recipients recovered eyesight. Cultures were positive with the same organism in the donor tissue and the recipient infection.
Demonstration of imputability or root cause:
Level 4 Certain. Same unusual microbe found in recipient infection and donor rim.