J Korean Ophthalmol Soc.  2012 Aug;53(8):1167-1171. 10.3341/jkos.2012.53.8.1167.

A Case of Keratitis Caused by Combined Infection of Multidrug-Resistant Acinetobacter Baumannii and Candida Parapsilosis

• Choi JK
• Kim IH
• Seo JW

• KMID: 2215962
• DOI: http://doi.org/10.3341/jkos.2012.53.8.1167

Abstract

PURPOSE
To report a case of keratitis caused by Acinetobacter baumannii and Candida parapsilosis in a patient using 0.5% levofloxacin and 0.1% fluorometholone for an extended period of time.
CASE SUMMARY
A 55-year-old male patient in the neurosurgery department with conjunctival injection and discharge in his left eye was consulted for ophthalmic evaluation and treatment. He was hospitalized in the state of akinetic mutism and given 0.5% levofloxacin and 0.1% fluorometholone for 2 years. On slit-lamp examination, a 3.5 x 4.5-mm dense stromal infiltrate with an overlying epithelial defect was observed. Corneal scraping culture revealed multidrug-resistant A. baumannii and C. parapsilosis. According to the susceptibility result, the patient was treated with topical 10% piperacillin/tazobactam and 0.125% amphotericin B hourly. The corneal ulcer healed gradually with corneal opacity remaining after 8 weeks of treatment.
CONCLUSIONS
The authors of the present study report a case of treated multidrug-resistant A. baumannii and C. parapsilosis keratitis in a patient using topical antibiotics and steroid for an extended period of time.

Keyword

Acinetobacter baumannii; Candida parapsilosis; Combined infection; Keratitis; Multidrug-resistant

MeSH Terms

Acinetobacter
Acinetobacter baumannii
Akinetic Mutism
Amphotericin B
Anti-Bacterial Agents
Candida
Corneal Opacity
Corneal Ulcer
Eye
Fluorometholone
Humans
Keratitis
Male
Middle Aged
Neurosurgery
Ofloxacin
Amphotericin B
Anti-Bacterial Agents
Fluorometholone
Ofloxacin

Figure

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  Figure 1 Anterior segment photographs on the first ophthalmic examination showing severe conjunctival injection, corneal stromal infiltration, corneal scar and neovascularization (arrows).

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  Figure 2 Characteristics of A. baumannii. Initial photograph shows multiple colonies on MacConkey agar, each colony shows non-pigmented, dome-shaped cluster (A), Gram-stain showed gram-negative coccobacilli (B).

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  Figure 3 Characteristics of C. parapsilosis. Photograph shows small white colonies on Sabouraud dextrose agar (A), microscopic findings of colonies show budding forms (arrows) (B).

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  Figure 4 After treatment for 8 weeks, quiet corneal scarring was evident (arrows).

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