J Korean Ophthalmol Soc.  2016 Aug;57(8):1307-1311. 10.3341/jkos.2016.57.8.1307.

A Case of Successful Treatment Using Topical Colistin in Multidrug-resistant Pseudomonas aeruginosa Bacterial Ulcer

• Seo MH
• Na YH
• Lee DH
• Kim JH

• KMID: 2349081
• DOI: http://doi.org/10.3341/jkos.2016.57.8.1307

Abstract

PURPOSE
To report a successful case of corneal ulcer caused by multidrug-resistant Pseudomonas aeruginosa using topical colistin in an immobilized patient who was hospitalized for a long period.
CASE SUMMARY
An immobilized 58-year-old female who was admitted for a long stay due to cerebral aneurysm hemorrhage presented with left ocular discharge and hyperemia, and was referred to our clinic. The patient was treated at a local clinic with topical antibiotics, but showed no improvement. At initial visit, she had difficulty communicating with the medical team and taking ophthalmic examination, and she had severe chemosis and corneal infiltration, corneal opacity, and hypopyon on her left eye with a portable slit lamp. Gram staining, bacterial and fungal cultures, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Pseudomonas aeruginosa, which is resistant to all antibiotics except colistin. As soon as we were aware of the results of the antibiotic sensitivity test, she was treated with topical colistin 0.19% every 1 hour on her left eye, starting immediately. After 28 days of treatment, the infection was resolved except for the remaining corneal opacity. She had a persisted stable corneal lesion at 1-year-follow up after colistin treatment, which indicated no recurrence.
CONCLUSIONS
Due to gait disturbance, the patient almost missed appropriate ophthalmic examination or treatment. However, as we started immediate topical colistin treatment, we report a successful therapy of corneal ulcer induced by multidrug-resistant Pseudomonas aeruginosa without severe complications, such as perforation.

Keyword

Colistin; Corneal ulcer; Multidrug-resistant Pseudomonas aeruginosa

MeSH Terms

Anti-Bacterial Agents
Colistin*
Corneal Opacity
Corneal Ulcer
Female
Gait
Hemorrhage
Humans
Hyperemia
Intracranial Aneurysm
Middle Aged
Pseudomonas aeruginosa*
Pseudomonas*
Recurrence
Slit Lamp
Ulcer*
Anti-Bacterial Agents
Colistin

Figure

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  Figure 1. Anterior segment photography of cornea and conjunctiva of the left eye at the initial visit. (A) Three mm height of anterior chamber hypopyon, dense stromal infiltration and diffuse haze with a ground-glass appearance were observed in her cornea. (B) Severe chemosis with hyperemia and marked suppuration were shown in her conjunctiva.

• 

  Figure 2. Anterior segment photographies of the affected eye by lapse of time. (A) Disappeared hypopyon but still remained corneal epithelial defect about 3 mm in size on the 5th day of topical colistin treatment. (B) Regressed cornea epithelial defect on the 15th day of topical colistin treatment. (C) Anterior segment photography of cornea & conjunctiva of the left eye 28th day after the treatment representing reduced conjunctival inflammation but still remained corneal opacity. (D) Old corneal opacity without inflammation at the 1-year-follow up after topical colistin treatment representing no recurrence of corneal ulcer but remained slight conjunctival hyperemia due to therapeutic contact lens.

Reference

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