trimethoprim--sulfamethoxazole-drug-combination and Keratitis

Topics: Anti-Bacterial Agents; Female; Humans; Keratitis; Middle Aged; Nocardia; Nocardia Infections; Spain; Trimethoprim, Sulfamethoxazole Drug Combination

An 84 year-old woman with persistent epithelial defect and a dense stromal infiltrate post-corneal transplantation. According to the microbiological results, it was due to a Stenotrophomonas maltophilia (S. maltophilia) resistant to all antibiotics except trimethoprim-sulfamethoxazole (TMP/SMX). Healing was achieved after three weeks of treatment with oral and topical TMP/SMX.. S. maltophilia is an opportunistic microorganism rarely described in ophthalmology. It is associated with conjunctivitis, keratitis, scleritis, dacryrocystitis, cellulitis, and endophthalmitis with significant morbidity. Treatment is complicated because of its resistances to broad-spectrum antibiotics. TMP/SMX monotherapy can be considered an option of treatment for this type of keratitis.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Descemet Stripping Endothelial Keratoplasty; Diabetes Mellitus, Type 2; Female; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Keratitis; Opportunistic Infections; Stenotrophomonas maltophilia; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus (MRSA) infection is an important public health issue. The study aimed to characterize the patient demographics, clinical features, antibiotic susceptibility, and clinical outcomes of keratitis caused by S. aureus, and to make a comparison between MRSA and methicillin-sensitive S. aureus (MSSA) isolates.. Patients (n = 59) with culture-proven S. aureus keratitis treated in Chang Gung Memorial Hospital between January 1, 2006, and December 31, 2010, were included in our study. Patients' demographic and clinical data were retrospectively reviewed. Twenty-six MRSA (44%) and 33 MSSA (56%) isolates were collected. The MRSA keratitis was significantly more common among the patients with healthcare exposure (P = 0.038), but 46.2% (12/26) of patients with MRSA keratitis were considered to have community-associated infections. All isolates were susceptible to vancomycin. MRSA isolates were significantly more resistant to clindamycin, erythromycin, and sulfamethoxazole/trimethoprim. Ocular surface disease was a significant risk factor for MRSA keratitis (P = 0.011). Visual outcome did not differ significantly between the MRSA and MSSA groups. However, age (B = 0.01, P = 0.035, 95% confidence interval [CI]: 0.001-0.019) and visual acuity at presentation (B = 0.749, P<0.001, 95% CI: 0.573-0.926) were significantly correlated with visual outcome.. Ocular surface disease is an important predisposing factor for S. aureus keratitis, especially for MRSA infections. Advanced age and poor visual acuity at presentation are important prognostic indicators for poor visual outcome in S. aureus keratitis. Oxacillin resistance may not be a significant prognostic indicator.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Clindamycin; Erythromycin; Female; Humans; Infant; Keratitis; Male; Methicillin; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Oxacillin; Prognosis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Visual Acuity

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Aza Compounds; Drug Resistance, Bacterial; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Fluoroquinolones; Gatifloxacin; Humans; Keratitis; Microbial Sensitivity Tests; Moxifloxacin; Nocardia; Nocardia Infections; Quinolines; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

To describe the history, clinical presentation, and successful medical management of a case of multidrug-resistant Flavobacterium indologenes keratitis.. An 83-year-old pseudophakic female presented with a 2-day history of decreased visual acuity, light sensitivity and dull ocular pain in her right eye. Two weeks before presentation, the patient had been treated for a red eye with combination topical loteprednol etabonate (0.5%) and tobramycin (0.3%) eye drops. Corneal scrappings were performed by the referring ophthalmologist, and hourly administration of gatifloxacin 0.3% eye drops was started. Evaluation consisted of slit lamp examination, organism identification, and antibiotic sensitivity testing.. Examination of the right eye revealed a central 5-mm X 2-mm anterior stromal infiltrate with an overlying epithelial defect. Gatifloxacin 0.3% eye drops were stopped, and hourly topical fortified vancomycin (50 mg/mL) and ceftazidime (50 mg/mL) eye drops were instituted. Oxidase-positive gram-negative bacilli were identified in the thioglycollate broth on day 3, and therefore, vancomycin was discontinued and hourly ciprofloxacin 0.3% eye drops were added to the regimen. The cultures ultimately grew F. indologenes, which was highly resistant to all antibiotics tested except for trimethoprim-sulfamethoxazole. Accordingly, ciprofloxacin 0.3% and ceftazidime were discontinued. The patient was started on hourly topical trimethoprim (16 mg/mL)/sulfamethoxazole (80 mg/mL) eye drops, resulting in clinical control of the infection over a period of 1 month.. Flavobacterium indologenes keratitis can be resistant to treatment with many medications, and antibiotic susceptibility profile testing in these cases may provide crucial information to help eradicate the infection.

Topics: Aged, 80 and over; Anti-Infective Agents; Drug Resistance, Multiple, Bacterial; Female; Flavobacteriaceae Infections; Flavobacterium; Humans; Keratitis; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity

To report a case of microbial keratitis caused by Nocardia transvalensis with resistance to amikacin.. Case report.. A 51-year-old man was referred with a 10-week history of ocular pain, photophobia, redness, and blurred vision. At his initial presentation, a corneal foreign body was removed and he was diagnosed with anterior uveitis, with commencement of topical corticosteroid therapy and ofloxacin. Despite treatment, he experienced ongoing foreign body sensation and glare. At presentation to our clinic, a central epithelial defect with multiple stromal infiltrates in a wreath pattern was identified and a diagnosis of infective keratitis was made. He was initially commenced on topical amikacin, oral trimethoprim-sulfamethoxazole, and oral voriconazole. Corneal scraping confirmed Nocardia species. Microbiological culture revealed N. transvalensis as the causative organism, with resistance to several antibiotics, including amikacin. Clinically, there was only partial response of the keratitis to initial therapy. Treatment was changed to oral trimethoprim-sulfamethoxazole and topical ciprofloxacin, with eventual clinical improvement.. This is the first reported case of N. transvalensis keratitis. In patients with Nocardia keratitis and only partial response to amikacin treatment, this isolate should be considered as it is resistant to aminoglycoside antibiotics.

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Humans; Keratitis; Male; Middle Aged; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

To describe a new technique, pyrosequencing, which allows for the rapid identification of Mycobacterium and Nocardia species.. Interventional case report.. The medical records of a patient presenting with an infectious keratitis were reviewed.. A case of Nocardia abscessus/arthrititis/asiatica keratitis was diagnosed in a young individual with the aid of pyrosequencing technology. Based on presumed antibiotic sensitivities, therapy with topical trimethoprim-sulfamethoxazole eyedrops was initiated, and the infection was cleared rapidly with minimal residual scarring.. Pyrosequencing may be a useful tool in aiding the rapid diagnosis and treatment of ocular infections caused by slow-growing pathogens.

Topics: Adult; Anti-Infective Agents; Bacterial Typing Techniques; Base Sequence; DNA, Bacterial; Eye Infections, Bacterial; Humans; Keratitis; Male; Molecular Sequence Data; Nocardia; Nocardia Infections; Ophthalmic Solutions; Sequence Analysis, DNA; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Ciprofloxacin; Contact Lenses, Extended-Wear; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Keratitis; Male; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of sclerokeratitis caused by Nocardia asteroides in a soft contact lens wearer.. A 65-year-old male presented with a 2-month history of a corneal ulcer in the left eye. He wore two weekly disposable soft contact lenses on an extended basis. He revealed his history of gardening before the onset of symptoms. On examination, his best-corrected visual acuity was 20/30 in the right eye and 20/400 in the left eye. In the left eye, there was conjunctival injection. His cornea showed multiple patchy infiltrates, with a feathery border that was raised and involved up to the midstroma. There was a 3+ anterior chamber reaction. Corneal scrapings were performed for smears and cultures. Topical 2% amikacin sulfate every half hour along with oral clarithromycin therapy was initiated. On follow-up, the sclera lesions worsened.. Smears of corneal scrapings revealed gram-positive filamentous bacteria in Gram's stain. The cultures grew Nocardia asteroides. The patient was switched to trimethoprim-sulfamethoxazole (Bactrim DS, Roche Laboratories, Nutley, NJ) as the sclera was involved. The patient responded to treatment, and the infection resolved. When last seen, approximately 4 months after his initial presentation to us, his visual acuity was 20/40 in the affected eye. There was corneal scarring, and the adjacent sclera showed thinning.. Nocardia sclerokeratitis can be associated with contact lens wear. Nocardia should be considered in the differential diagnosis of a corneal ulcer with an indolent progressive course with feathery infiltrates. Topical amikacin and systemic trimethoprim-sulfamethoxazole are effective drugs in the treatment of nocardial corneal infection with scleral involvement.

Topics: Aged; Anti-Bacterial Agents; Contact Lenses, Extended-Wear; Humans; Keratitis; Male; Nocardia asteroides; Nocardia Infections; Scleritis; Trimethoprim, Sulfamethoxazole Drug Combination

The conventional treatment of Nocardia keratitis is with topical sulfonamides. Recently, topical trimethoprim and sulfamethoxazole (Bactrim) has been suggested as treatment. This study compares the in vitro efficacy against Nocardia asteroides of Bactrim and various ratios of trimethoprim and a sulfonamide.. Antibiotic disks were soaked with various ratios of trimethoprim and sulfacetamide sodium. They contained trimethoprim alone, sulfacetamide sodium alone, and both trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5. Disks containing Bactrim were also prepared. Each disk was placed on blood agar plates streaked with N. asteroides. The plates were incubated at 37 degrees C for 72 hours and then examined.. Trimethoprim alone showed minimal effect. Sulfacetamide sodium alone had a clearance zone of 12 mm. The plates of trimethoprim and sulfacetamide sodium at ratios of 1:40, 1:20, and 1:5 had clearance zones of 14 mm, 17 mm, and 27 mm, respectively. Bactrim had a clearance zone of 70 mm.. Trimethoprim or sulfacetamide sodium alone is not as effective as both drugs together. As the ratio of the two drugs was changed, potency differed against Nocardia organisms. Bactrim was the most effective antibiotic against Nocardia organisms. It should be the recommended agent for the treatment of Nocardia keratitis.

Topics: Administration, Topical; Adult; Anti-Infective Agents, Local; Cornea; Eye Infections, Bacterial; Humans; Keratitis; Male; Microbial Sensitivity Tests; Nocardia asteroides; Nocardia Infections; Ophthalmic Solutions; Sulfacetamide; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of Alcaligenes xylosoxidans keratitis following penetrating keratoplasty in a rigid gas permeable (RGP) lens wearer.. A 61 year old RGP lens wearer with a history of nonresponsive keratitis of the right eye which involved the graft margin was referred to us for treatment. Corneal cultures revealed growth of a gram-negative rod on the fifth day and the organism was subsequently identified as Alcaligenes xylosoxidans, which was resistant to most antibiotics and sensitive only to Bactrim, Timentin, and imipenem.. Clinical improvement was observed within 24 hours after treatment with the use of topical i.v. Bactrim and topical i.v. Timentin 2% alternating every 30 minutes. Complete resolution of the infection with mild scarring was observed 6 weeks after treatment.. Alcaligenes xylosoxidans is a potential cause of bacterial keratitis which should be considered in cases of nonresponsive gram-negative keratitis. The addition of topical Bactrim or Timentin may need to be considered in such cases.

Topics: Administration, Topical; Alcaligenes; Anti-Bacterial Agents; Bacterial Infections; Clavulanic Acids; Contact Lenses; Cornea; Drug Therapy, Combination; Gases; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Permeability; Postoperative Complications; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

An elderly male presented with epithelial defect which resisted all medical and therapeutic approaches until Gram stain and cultural report documented the presence of Nocardia asteroides of the offending organism. A 3-month course of chronic keratitis with persistent epithelial defect resolved in 48 h following the use of topical trimethoprim-sulfamethoxazole.

Topics: Aged; Bacteriological Techniques; Cornea; Drug Combinations; Epithelium; Humans; Infusions, Intravenous; Keratitis; Male; Nocardia asteroides; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Combinations; Humans; Keratitis; Male; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination