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Merle Fernandes, Avinash Pathengay, Nagendra Kumar; Emergence Of Pan-drug Resistant Pseudomonas Aeruginosa As A Cause Of Microbial Keratitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6194.
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To describe the management and outcome of 6 cases of pan-drug resistant Pseudomonas aeruginosa keratitis
6 patients with age ranging from 23 to 65 years of whom 50% were male, presented with microbial keratitis of durations varying from 1 day to 2 months. Three of them had penetrating keratoplasty (PKP) for microbial keratitis earlier. One patient had Stevens Johnson syndrome (SJS) and 1 had corneal decompensation following glaucomatous optic atrophy. All patients underwent corneal scrapings. Grams stain and 10% KOH mount were done. The material was also inoculated on blood agar, chocolate agar, Sabouraud’s dextrose agar, potato dextrose agar, brain heart infusion broth and thioglycollate broth.
All Grams stains showed Gram negative bacilli. Cultures grew Pseudomonas aeruginosa resistant to all antibiotics except colistin in 4 cases. These cases received 0.1% Colisthimetate eyedrops. Three did not respond and underwent PKP. The patient with SJS had a recurrence of the same infection 4 weeks after PKP which was treated with 0.1% Colistin eyedrops. The 4th patient resolved with scarring after 2 months treatment. In one patient, cultures grew Pseudomonas aeruginosa sensitive to Azithromycin alone and the infection resolved on this treatment. In another case, Pseudomonas aeruginosa sensitive only to Imipenem and Colistin was grown and the infection resolved on 1% Imipenem eyedrops.
Pan-drug resistant Pseudomonas aeruginosa keratitis is emerging as an important cause of bacterial keratitis. Patients with compromised ocular surface following corneal transplantation or Stevens Johnson syndrome or corneal decompensation may be at risk. Medical management with colistin, imipenem and azithromycin eyedrops was effective in only half of the cases and therapeutic PKP was done in the remaining.
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