J Korean Ophthalmol Soc.  2019 May;60(5):474-479. 10.3341/jkos.2019.60.5.474.

Polymicrobial Keratitis of Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi

• Kang JY
• Song JH
• Nam KY
• Lee SU
• Lee SJ

• KMID: 2445142
• DOI: http://doi.org/10.3341/jkos.2019.60.5.474

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.
CONCLUSIONS
We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.

Keyword

Acinetobacter baumannii; Keratitis; Ochrobactrum anthropi; Pseudomonas aeruginosa

MeSH Terms

Acinetobacter baumannii*
Acinetobacter*
Anterior Chamber
Ceftazidime
Corneal Ulcer
Cyclopentolate
Doxycycline
Eyelids
Female
Gentamicins
Humans
Hyperemia
Inflammation
Keratitis*
Middle Aged
Ochrobactrum anthropi*
Ochrobactrum*
Pseudomonas aeruginosa*
Pseudomonas*
Republic of Korea
Slit Lamp
Ultrasonography
Visual Acuity
Voriconazole
Ceftazidime
Cyclopentolate
Doxycycline
Gentamicins
Voriconazole

Figure

• 

  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).

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