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Abstract
Purpose
To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi.
Case summary
A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation.
Figures and Tables
Figure 1
Anterior segment photographs on the first ophthalmic examination showed severe conjunctival injection, hypopyon and corenal stromal ring infiltration (A, B), Photograph showed multiple colonies of Pseudomonas aeruginosa on MacConkey agar, gram-stain showed gram-negative bacilli (C, D), Photograph showed multiple colonies of Acinetobacter baumannii on MacConkey agar, gram-stain showed gram-negative cocobacilli (E, F). Eight days after treatment, decreased corneal infiltration and hypopyon are observed (G, H).
Figure 2
Thirteen days after treatment, corneal infiltration and hypopyon increased again (A, B). Photograph showed multiple colonies of Ochrobactrum anthropi on 5% blood agar, gram-stain showed gram-negative bacilli (C, D). Twenty days after treatment, anterior segment OCT showed subtle Descemet's membrane detachment (E, yellow arrow). Five months after conjunctival flap, neovascularization and quiet corneal scarring are observed (F).
Notes
References
1. Hahn YH, Lee SJ, Tchah HW, et al. Epidemiology of Pseudomonas keratitis : a multi-center study. J Korean Ophthalmol Soc. 1999; 40:2411–2422.
2. Kim ST, Lee YC, Heo J, Koh JW. A case of acinetobacter baumannii keratitis after contact lens wearing. J Korean Ophthalmol Soc. 2008; 49:1696–1700.
3. Shin KY, Cho KJ. Clinical features of acinetobacter baumannii keratitis. J Korean Ophthalmol Soc. 2015; 56:607–613.
4. Choi JK, Kim IH, Seo JW. A case of keratitis caused by combined infection of multidrug-resistant acinetobacter baumannii and candida parapsilosis. J Korean Ophthalmol Soc. 2012; 53:1167–1171.
5. Venkateswaran N, Wozniak RA, Hindman HB. Ochrobactrum anthropi keratitis with focal Descemet's membrane detachment and intracorneal hypopyon. Case Rep Ophthalmol Med. 2016; 2016:4502105.
6. Braun M, Jonas JB, Schönherr U, Naumann GO. Ochrobactrum anthropi endophthalmitis after uncomplicated cataract surgery. Am J Ophthalmol. 1996; 122:272–273.
7. Chiang CC, Tsai YY, Lin JM, Chen WL. Chronic endophthalmitis after cataract surgery secondary to Ochrobactrum anthropi. Eye (Lond). 2009; 23:1237–1238.
8. Kim KS, Han JW, Lee WK. A case of Ochrobactrum anthropi endophthalmitis after cataract surgery. J Korean Ophthalmol Soc. 2003; 44:1943–1947.
9. Romero Gómez MP, Peinado Esteban AM, Sobrino Daza JA, et al. Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi: case report. J Clin Microbiol. 2004; 42:3371–3373.
10. Chain PS, Lang DM, Comerci DJ, et al. Genome of Ochrobactrum anthropi ATCC 49188 T, a versatile opportunistic pathogen and symbiont of several eukaryotic hosts. J Bacteriol. 2011; 193:4274–4275.
11. Eveillard M, Kempf M, Belmonte O, et al. Reservoirs of Acinetobacter baumannii outside the hospital and potential involvement in emerging human community-acquired infections. Int J Infect Dis. 2013; 17:e802–e805.
12. Ruiz J, Núñez ML, Pérez J, et al. Evolution of resistance among clinical isolates of Acinetobacter over a 6-year period. Eur J Clin Microbiol Infect Dis. 1999; 18:292–295.
13. Peleg AY, Paterson DL. Multidrug-resistant Acinetobacter: a threat to the antibiotic era. Intern Med J. 2006; 36:479–482.
14. Thoma B, Straube E, Scholz HC, et al. Identification and antimicrobial susceptibilities of Ochrobactrum spp. Int J Med Microbiol. 2009; 299:209–220.
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