Extensively and pan-drug resistant Pseudomonas aeruginosa keratitis: clinical features, risk factors, and outcome

Fernandes, Merle; Vira, Divya; Radhika, Medikonda; Kumar, Narendra

doi:10.1007/s00417-015-3208-7

Cited by 69 publications

(61 citation statements)

References 27 publications

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“…In addition P. aeruginosa acquires spontaneous genetic mutations based on the antibiotic therapy and the environment and transfers those mutated genetic elements horizontally between cells, further reducing its susceptibility to antibiotics [63]. Recently, it was reported that inappropriate use of antibiotics along with other risk factors caused a breakthrough resistance in P. aeruginosa , which resulted in emergence of multi-drug resistant (MDR), extensively drug resistant (EXD) and pan-drug resistant (PDR) P. aeruginosa strains with no or minimum effective antibiotic therapy [63, 64]. Encounter with these highly resistant bacteria poses immense therapeutic challenge.…”

Section: Antibioticsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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Introduction Ocular infections remain an important cause of blindness worldwide and represent a challenging public health concern. In this regard, microbial keratitis due to fungal, bacterial, or viral infection can result in significant vision loss secondary to corneal scarring or surface irregularity. Left untreated corneal perforation and endophthalmitis can result, leading to loss of the eye. Rigorously studied animal models of disease pathogenesis have provided novel information that suggests new modes of treatment that may be efficacious clinically and emerging clinical data is supportive of some of these discoveries. Areas covered This review focuses on advances in our understanding of disease pathogenesis in animal models and clinical studies and how these relate to improved clinical treatment. We also discuss a novel approach to treatment of microbial keratitis due to infection with these bacterial pathogens using PACK-CXL and recommend increased basic and clinical studies to address and refine the efficacy of this procedure. Expert commentary Because resistance to antibiotics has developed over time to these bacterial pathogens, caution must be exercised in treatment. Attractive novel modes of treatment that hold new promise for further investigation include lipid based therapy, as well as use of small molecules that bind deleterious specific host responsive molecules and use of microRNA based therapies.

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Section: Antibioticsmentioning

confidence: 99%

Challenges of corneal infections

Hazlett

Suvas

McClellan

et al. 2016

Expert Review of Ophthalmology

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“…The carbapenems antibiotics are commonly used in human multi-resistant pseudomonas infections. The lack of apparent resistance of P. aeruginosa strains to imipenem should be highlighted, especially when compared to those findings obtained from cases of human P. aeruginosa isolates, in which the in vitro resistance can reach 4% (Mohammadpour et al, 2011) to 40% (Fernandes et al, 2015). Although this drug is rarely used in veterinary medicine and is not approved for use in animals by the Food and Drug Administration, veterinarians can legally prescribe imipenem as an extra-label drug for ocular infections consisting of multi-resistant strains of P. aeruginosa.…”

Section: Susceptibility Testsmentioning

confidence: 90%

Antimicrobial susceptibility and minimal inhibitory concentration of <i>Pseudomonas aeruginosa</i> isolated from septic ocular surface disease in different animal species

Leigue¹,

Montiani‐Ferreira²,

Moore³

2016

Open Vet J.

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The purpose of this study was to evaluate the antibiotic susceptibility profile of Pseudomonas aeruginosa isolated from different animal species with septic ocular surface disease. Sixteen strains of P. aeruginosa were isolated from different species of animals (dog, cat, horse, penguin and brown bear) with ocular surface diseases such as conjunctivitis, keratocojnuctivits sicca and ulcerative keratitis. These isolates were tested against 11 different antimicrobials agents using the Kirby-Bauer disk-diffusion method. Minimum inhibitory concentrations (MICs) were determined using E-tests for two antibiotics (tobramycin and ciprofloxacin) commonly used in veterinary ophthalmology practice. Imipenem was the most effective antibiotic, with 100% of the strains being susceptible, followed by amikacin (87.5%), gentamicin, norfloxacin, gatifloxacin and polymyxin (both with 81.5%of susceptibility). MIC90 of ciprofloxacin was 2 µg/ml and the values found ranged from 0.094 µg/ml to 32 µg/ml. For tobramycin, MIC90 was 32 µg/ml and ranged from 0.25 µg/ml to 256 µg/ml. The most effective in vitro antibiotic tested against P. aeruginosa in this study was imipenem, followed by amikacin. The 3 mg/ml eye drops commercially available ciprofloxacin presentations were in vitro effective against all strains tested in this study if applied up to 4 hours after instillation. Whereas for tobramycin the 3 mg/ml eye drops commercial presentations were not in vitro effective against some strains isolated in this study. Thus for ocular infections with P. aeruginosa when using tobramycin the ideal recommendation would be to either use eye drops with higher concentrations or decrease the frequency intervals from four to a minimum of every two hours.

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“…Risk factors for multiple and extremely drug resistance Pseudomonas include: bandage contact lens, topical steroids, previous corneal graft and ocular surface disease following Steven Johnson disease [28].…”

Section: Epidemiology P Aeruginosa Keratitismentioning

confidence: 99%

Management of Psuedomonas Keratitis: a review article

Alsaad¹

2017

int. arab. j antimicrob. agents

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Bacterial keratitis can lead to severe vision loss and corneal scarring, and possibly perforation. Early and appropriate management is a key factor in decreasing and preventing complication.Pubmed and Medline were searched for articles related to Pseudomonas keratitis between year 2000 and 2017 to get current guidelines about the management of Pseudomonas keratitis. These articles are reviewed in this article and information related to management is summarized.The most used agents to treat Pseudomonas are either aminoglycosides (usually gentamicin) fortified with a cephalosporin or mono therapy with a fluoroquinolones usually ciprofloxacin. In most areas, most strains of Pseudomonas were susceptible to ciprofloxacin. The role of topical steroids is discussed, as well as, available options for treatment of multidrug resistant Pseudomonas species.

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Extensively and pan-drug resistant Pseudomonas aeruginosa keratitis: clinical features, risk factors, and outcome

Abstract: XDR and PDR Pseudomonas aeruginosa keratitis are extremely difficult to treat. Globe salvage was possible in all cases; however, more than half required therapeutic grafts. Close monitoring of patients with known ocular and systemic factors is warranted.

Cited by 69 publications

References 27 publications

Challenges of corneal infections

Challenges of corneal infections

Antimicrobial susceptibility and minimal inhibitory concentration of <i>Pseudomonas aeruginosa</i> isolated from septic ocular surface disease in different animal species

Management of Psuedomonas Keratitis: a review article

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