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Jeffry Hogg, Arthur Okonkwo, Manjusha Narayanan, We Fong Siah, Francisco C Figueiredo; Stenotrophomonas maltophilia Keratitis - A Case Series of a Rare Form of Keratitis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5645.
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Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic pathogen that may result in debilitated vision in cases of keratitis due to its resistance to many broad-spectrum antibiotics. There is a paucity of reports in the literature on the management of S. maltophilia keratitis with poor consensus on antibiotic choice. Here, we highlight its predisposing factors, management and visual outcomes.
A retrospective analysis of medical records of all microbiology confirmed and consecutive patients presenting with S. maltophilia keratitis to the Royal Victoria Infirmary, Newcastle upon Tyne, UK, between January and October 2014 was performed. Successful treatment was defined as the complete resolution of the corneal ulceration.
Four cases were identified (2 male, 2 female) with a mean age of 69.7 (range 56.2-90.1) years. One patient had a recent ex vivo expanded autologous limbal stem cell on intact amnion transplantation, 1 had a neurotrophic keratopathy, 1 had a recent surgical repair of a corneal laceration and 1 had a failed penetrating keratoplasty with a history of herpetic eye disease. At presentation, 3 patients had bandage contact lens, 2 were on topical antibiotics and 1 also had concurrent use of topical steroid and glaucoma medication. The initial treatment on presentation for all 4 patients was topical 0.3% ofloxacin and topical 5% cefuroxime which was modified based on corneal scraping culture and sensitivity and clinical outcomes. One patient did not complete the treatment course due to non-compliance. The remaining 3 had successful treatment; patient with a neurotrophic cornea responded to topical 0.5% chloramphenicol and systemic ceftazidime; patient with limbal stem cell transplant had a large ulceration and a descemetocele, responded to topical 0.3% ofloxacin, topical 0.3% ciprofloxacin, oral ciprofloxacin and oral co-trimoxazole; patient with failed corneal graft responded to topical 0.3% ofloxacin, topical 0.5% chloramphenicol and oral co-trimoxazole. Following treatment, visual acuity returned to baseline in 2 patients but declined in 1 from counting fingers to hand movements.
Ocular surface problems coupled with chronic topical antibiotic and contact lens may predispose an individual to develop S. maltophilia keratitis. We report successful treatment with a combination of antibiotics such as fluoroquinolone, co-trimoxazole and/or cephalosporin agent.
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