trimethoprim--sulfamethoxazole-drug-combination and Corneal-Ulcer

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Chryseobacterium; Conjunctiva; Corneal Ulcer; Drug Resistance, Multiple, Bacterial; Female; Flavobacteriaceae Infections; Humans; Surgical Flaps; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia, an uncommon cause of infectious keratitis, is difficult to treat because of its resistance to multiple antibiotics. The purpose of this study is to describe the clinical features, antibiotic susceptibility profile, and outcomes of S. maltophilia keratitis.. A retrospective review of records from 1987 to 2016 identified 26 eyes of 26 patients who were treated at the Bascom Palmer Eye Institute for an S. maltophilia corneal ulcer. Clinical data were analyzed as to predisposing factors, clinical presentation, antibiotic susceptibility, treatment selection, and clinical outcomes.. Median age at presentation was 65 years (range, 16-98). Twelve patients were using topical corticosteroids, 8 patients had a history of penetrating keratoplasty, and 9 were contact lens wearers. All patients received topical antibiotics, 2 required therapeutic penetrating keratoplasty, and 1 was enucleated. At presentation, 57.7% (15/26) of the patients had visual acuity of 20/400 or worse. At the final visit, only 30.4% (7/23) of the patients had visual acuity worse than 20/400, whereas 65.2% (15/23) of the patients had 20/100 or better. Almost all isolates (25/26, 96.2%) were susceptible to fluoroquinolones and 77.3% (17/22) of them to polymyxin B/trimethoprim. Only 33.3% (5/15) of the tested isolates were susceptible to aminoglycosides and 58.3% (7/12) to cephalosporins.. Infectious keratitis due to S. maltophilia presents a treatment challenge because of its resistance to aminoglycosides and cephalosporins, which are typically used for empiric broad-spectrum gram-negative coverage as fortified solutions. Fluoroquinolones and polymyxin B/trimethoprim should be considered instead in cases of S. maltophilia infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Ciprofloxacin; Corneal Ulcer; Eye Infections, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Polymyxin B; Retrospective Studies; Risk Factors; Stenotrophomonas maltophilia; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To describe the novel use of femtosecond laser technology for therapeutic resection of infectious foci in a case of multidrug-resistant Nocardia asteroides keratitis.. A 30-year-old man presented with a corneal infiltrate. Cultures were taken, and fortified vancomycin and tobramycin were initiated. After 3 negative cultures and minimal improvement on various broad-spectrum antibiotics, all topical medications were stopped and a final fourth corneal culture grew N. asteroides. Treatment with topical amikacin was initiated, but the infection continued to worsen. With drug sensitivities still pending, the patient's clinical status continued to deteriorate rapidly, despite treatment with amikacin, gatifloxacin, and polymyxin B/trimethoprim. The femtosecond laser was then used to perform targeted lamellar keratectomy.. Femtosecond laser-assisted lamellar keratectomy successfully removed the infected tissue and allowed for increased penetration of topical antibiotics. Drug sensitivities finally returned, revealing multidrug resistance and sensitivity only to trimethoprim/sulfamethoxazole and tobramycin, some of which the patient had previously tried and failed. The infection fully resolved after readministering polymyxin B/trimethoprim and tobramycin, leaving minimal residual scarring.. Multidrug-resistant N. asteroides keratitis can be difficult to manage even with appropriate antibiotic therapy based on drug sensitivity testing. Femtosecond laser-assisted resections may facilitate treatment in these cases by safely and precisely debulking infected tissue and enhancing penetration of topical medications.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Corneal Surgery, Laser; Corneal Ulcer; Drug Resistance, Multiple, Bacterial; Eye Infections, Bacterial; Humans; Male; Nocardia asteroides; Nocardia Infections; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amikacin; Anti-Bacterial Agents; Corneal Ulcer; Eye Infections, Bacterial; Humans; Kanamycin Resistance; Male; Microbial Sensitivity Tests; Microscopy, Confocal; Nocardia; Nocardia Infections; Ophthalmic Solutions; Sulfacetamide; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To describe 2 cases of Nocardia keratitis resistant to topical compounded amikacin therapy.. A 24-year-old woman presented with a corneal infiltrate. Cultures were taken, and topical moxifloxacin was administered. Corneal biopsy was performed when clinical status deteriorated, which confirmed infection with Nocardia. The patient was administered topical compounded amikacin. When clinical status further deteriorated, she was switched to compounded trimethoprim-sulfamethoxazole, which resulted in rapid resolution. Separately, a 22-year-old woman presented with contact lens-related keratitis that grew Nocardia asteroides. Corneal cultures and drug sensitivity testing revealed a strain of N. asteroides resistant to amikacin and imipenem, but sensitive to tobramycin. After a protracted clinical course, the keratitis ultimately responded to topical tobramycin leaving the patient with a pericentral corneal scar.. Nocardia keratitis is an atypical infection for which standard management algorithms exist. However, atypical cases require that these patients be followed closely for the response to therapy.

Topics: Administration, Topical; Amikacin; Anti-Bacterial Agents; Contact Lenses, Hydrophilic; Corneal Ulcer; Eye Infections, Bacterial; Female; Humans; Kanamycin Resistance; Microbial Sensitivity Tests; Nocardia asteroides; Nocardia Infections; Ophthalmic Solutions; Tobramycin; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Actinomycetales; Actinomycetales Infections; Corneal Stroma; Corneal Ulcer; DNA, Bacterial; DNA, Ribosomal; Eye Infections, Bacterial; Gram-Negative Bacterial Infections; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

To report a cluster of Nocardia asteroides keratitis cases after LASIK.. Retrospective review of the history and examination of three patients (four eyes) operated on the same day at a single center who developed postoperative keratitis. All patients underwent lifting of the superficial flap for microbiologic evaluation of the corneal scrapings. The operating surgeon was contacted to identify the possible source of contamination.. Two patients underwent simultaneous bilateral LASIK; however, only one developed postoperative keratitis in both eyes. One patient had unilateral surgery and developed keratitis in the operated eye. Microscopic examination of smears from all eyes revealed thin, branching, acid-fast, filamentous bacteria that were identified as Nocardia asteroides after culture. The infiltrates resolved with topical administration of amikacin sulphate (2.5%) and topical and oral trimethoprim-sulfamethoxazole. Final visual acuity ranged between 20/25 and 20/80. The operating surgeon had used the same blade and microkeratome in all patients.. Nocardia, a relatively unusual organism, can cause an epidemic of infection after LASIK.

Topics: Amikacin; Cefazolin; Cluster Analysis; Corneal Ulcer; Drug Therapy, Combination; Equipment Contamination; Eye Infections, Bacterial; Humans; Keratomileusis, Laser In Situ; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Refractive Surgical Procedures; Retrospective Studies; Surgical Flaps; Trimethoprim, Sulfamethoxazole Drug Combination

To correlate the clinical presentation and treatment outcome of Nocardia keratitis with the time to diagnosis, different species and with the drug sensitivity pattern.. Patients with Nocardia corneal ulcers were studied at a tertiary eye care center. Speciation of Nocardia isolates was done by sequencing the 16s rRNA gene. Clinical response to treatment was assessed by chart review.. Twenty one (65.3%) patients presented within 15 days of the onset of symptoms with typical clinical features of Nocardia keratitis, ie, a ring-like distribution of superficial infiltrates in a wreath pattern. Eight patients (25%) who presented after 15 days and within 30 days had an ulcer resembling fungal keratitis. N. Cyriacigeorgica (n = 11; 34.37%), N. asteroides (n = 9; 28%), N. farcinica (n = 7; 22%,) and N. Otitidiscaviarum (n = 5; 16%). All the species had 100% sensitivity to amikacin, sulphamethoxazole, imipenem and co-trimoxazole. Time to diagnosis of the infection was significantly associated with the different types of clinical presentation; those presenting early having the typical clinical picture (P = 0.004). Patients (73%) presenting within 15 days showed a highest recovery rate. (P = 0.045). The recovery time of the patients when compared with species showed those who were infected with N. cyriageorgica had a healing time of less than 15 days. Clinically, healing was faster when treated with 2% amikacin. Visual outcome improved in fourteen patients (44%) and sixteen (50%) patients remained the same (P = 0.0001).. Characteristic clinical picture of Nocardia is dependant on early presentation. It could be mistaken for fungal keratitis. Microbiological confirmation is important. Drug of choice for Nocardia keratitis is amikacin.

Topics: Adolescent; Adult; Aged; Amikacin; Anti-Bacterial Agents; Bacterial Typing Techniques; Child; Child, Preschool; Corneal Ulcer; DNA, Bacterial; Eye Infections, Bacterial; Female; Humans; Imipenem; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; Polymerase Chain Reaction; Retrospective Studies; RNA, Ribosomal, 16S; Sulfamethoxazole; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the clinical features, microbiological features and treatment outcome of nine patients with Nocardia keratitis treated with topical trimethoprim- sulphamethoxazole drops.. Retrospective review of nine patients with culture-proven Nocardia keratitis.. Nine patients with Nocardia keratitis were treated with topical trimethoprim-sulphamethoxazole drops. The average duration of treatment was 25 +/- 9 days. Five of the nine patients presented with superficial ulcers with margins studded with yellowish white discrete pinhead sized infiltration; the other four patients had deep stromal infiltration. Complete healing of the ulcer was achieved in six out of the nine patients with topical trimethoprim- sulphamethoxazole alone or in combination with ciprofloxacin 0.3% eye drops.. Topical application of trimethoprim-sulphamethoxazole appears to be effective therapy for superficial keratitis due to Nocardia.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Child; Ciprofloxacin; Corneal Ulcer; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Ophthalmic Solutions; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

A case of corneal ulceration due to infection with Nocardia asteroides is described. Microbiological examination of corneal scrapings permitted accurate diagnosis and suggested appropriate therapy. Nineteen other cases that have been described in the world literature are reviewed.

Topics: Adult; Cornea; Corneal Ulcer; Eye Infections, Bacterial; Humans; Male; Microbial Sensitivity Tests; Nocardia asteroides; Nocardia Infections; Sulfacetamide; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

Long-term sulfonamide therapy for a urinary tract disorder was believed to have caused toxicosis of the lacrimal gland, and subsequently, dry eyes. Initial topical treatment of the ulcers may have potentiated the dry eye condition. The dog was referred with negligible tear production and bilateral corneal ulcers. Diagnostic evaluation of the urinary tract indicated reflex dyssynergia, a neurologic disorder causing functional urinary tract obstruction. The combination of appropriate topical and surgical therapy of the eyes, discontinuation of sulfonamide treatment, and initiation of bethanechol in the treatment of reflex dyssynergia all contributed to return of a normal tear film. Any combination of systemic and/or topical therapy may affect lacrimal secretion. The clinician must be cognizant of the potential effects that systemic medication, particularly antimicrobial drugs and drugs affecting the autonomic nervous system, may have on lacrimal secretions.

Topics: Animals; Corneal Ulcer; Dog Diseases; Dogs; Drug Combinations; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urination Disorders

Topics: Adult; Chloramphenicol; Corneal Ulcer; Drug Combinations; Humans; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination