Management of multi drug resistant endogenous Klebsiella pneumoniae endophthalmitis with intravitreal and systemic colistin

Abstract

We report a case of a 35-year-old male with a pancreatic pseudocyst, who developed bilateral endogenous endophthalmitis, 4 days after surgical drainage of the pseudocyst. Bacterial cultures of the pancreatic drain fluid and the vitreous tap showed the growth of Klebsiella pneumoniae. The cultured organism was resistant to all the tested antibiotics except colistin. Intravenous colistin was instituted and three injections of intravitreal colistin were given in the left eye of the patient. Complete resolution of infection was seen and visual acuity of 6/6 was regained in both eyes, which was maintained at 4-month follow-up.

Endophthalmitis Management Study- a prospective randomized clinical trial on postoperative endophthalmitis management in India: An interim analysis. EMS Report # 3

“…Colistin has been used, and it is safe. [29,30,31,32] Also, if cost permits, targeted NGS may be added to the microbiology work-up.…”

Endophthalmitis Management Study—A Prospective Randomized Clinical Trial on Postoperative Endophthalmitis Management in India: An Interim Analysis. Endophthalmitis Management Study Report #3

“…Colistin has been used, and it is safe. [30][31][32][33] Targeted NGS may be added to the microbiology workup if cost permits.…”

Commentary: Management of endogenous endophthalmitis: Ophthalmologist in the role of a physician

“…In the present report titled “Management of multidrug-resistant Klebsiella pneumoniae EE with intravitreal and systemic colistin,” authors present clinical data of a patient of EE who was referred from gastroenterology department and was known to have pancreatitis. [ 4 ] This information was vital, and they could correlate the vitreous culture with the culture of pus obtained from pancreas; both of which yielded the same microorganism. This case highlights the need of working closely with treating internist to understand the exact etiology of EE which further enables ophthalmologist to pinpoint the microorganism and use appropriate antibiotic.…”

“…In the present case, authors have used intravitreal colistin (1000 IU/0.1 ml) to treat the multidrug-resistant K. pneumoniae EE. [ 4 ] The report of the use of intravitreal colistin is sparse in published literature. However, in cases with multidrug resistance, unconventional antibiotics become the likely agents to be considered.…”

“…[ 8 ] Authors have not mentioned the renal status of the patient in the current report. [ 4 ] It would be pertinent to keep the renal status of the patient in mind while administering systemic colistin, more so because EE can be seen in patients with deranged renal parameters due to primary renal disease.…”