Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty

Abstract

Rationale:Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature.Patient concerns:A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus.Diagnoses:Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface.Interventions:Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days.Outcomes:During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively.Lessons:Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.

Anterior Segment OCT: Clinical Applications

“…• AS-OCT helped in identifying the extension and depth of infiltrates in cases of anterior lamellar keratoplasties, guiding therapeutic choices. • Antibiogram revealed a multiresistant bacterium unresponsive to medical therapy that was treated with a therapeutic PKP with resolution of the case and improvement of corrected vision up to 0.8 [8]. • AS-OCT helps clinical decision in cases of corneal infection.…”

Bacterial isolates and antimicrobial susceptibility pattern of ocular infection at a tertiary referral hospital in the South of Italy

“…Ocular infections such as keratitis, endophthalmitis, blepharitis, orbital cellulitis, cellulitis and dacryocystitis are common ocular conditions caused by bacteria, viruses, fungi and parasites. 1,3 Among these conditions, bacterial infections are the major leading cause worldwide, accounting for 32 to 74% of all cases, according to different statistics. 4 Among Gram positive bacteria, the most common isolated are staphylococci; among Gram negative bacteria, the most common are P. Aeruginosa, which in contact lens wearers can lead to a threatening keratitis, and in children, Haemophilus influenzae.…”

“…Ocular infections such as keratitis, endophthalmitis, blepharitis, orbital cellulitis, cellulitis and dacryocystitis are common ocular conditions caused by bacteria, viruses, fungi and parasites. 1,3…”