Severe Keratitis Caused byPseudomonas aeruginosaSuccessfully Treated with Ceftazidime Associated with Acetazolamide

Abstract

Purpose. To report a case of microbial keratitis caused by Pseudomonas aeruginosa treated with a combination of acetazolamide and ceftazidime. Methods. Case report. Results. We report the case of a 17-year-old contact lens-wearing female who developed severe keratitis due to Pseudomonas aeruginosa temporarily healed with topical fortified antibiotic eye drops. After few days, the patient relapsed, and topical and intravenous ceftazidime were added. Concomitantly, oral administration of acetazolamide was prescribed. This carbonic anhydrase inhibitor was added to the antibiotic regimen in order to decrease the anterior chamber pH, and then, the ceftazidime ionization. By lowering the state of ionization of the antibiotic in the aqueous humor, its concentration was increased. This was confirmed by an improvement of the patient within few days and a rapid eradication of the infection. Conclusion. This is the first reported case of keratitis caused by P. aeruginosa successfully treated using acetazolamide as an enhancer of ceftazidime effectiveness.

It’s Not Easy Being Green: A Narrative Review on the Microbiology, Virulence and Therapeutic Prospects of Multidrug-Resistant Pseudomonas aeruginosa

“…Possible clinical manifestations include pneumonia (mainly ventilator-associated (VAP; 10-30%), while the community-acquired form is far less common (CAP; 1-3%)), skin and soft tissue infections associated with burns and surgeries (8-10%), "hot tub" folliculitis, "swimmer's ear" otitis externa, eye infections (keratitis), urinary tract infections (UTI; 813.8615%), endocarditis, and bacteremia/sepsis (central-line-associated or often secondary to pneumonia) [125][126][127][128][129][130]133]. Among bacterial pathogens responsible for contact lensassociated keratitis, P. aeruginosa has the worst disease manifestation (i.e., the development of a corneal ulcer, which may occur in 40-60% of cases), leading to poor outcomes, the fulminant destruction of the cornea, and vision loss [73,134,135]. The mortality rate of pseudomonad infections is a big concern among immunocompromised and hospitalized patients, which is around 25-39% for pneumonia and 18-61% for bacteremia, while these rates may be higher (40-70%) in case of MDR isolates [136][137][138].…”

“…The mortality rate of pseudomonad infections is a big concern among immunocompromised and hospitalized patients, which is around 25-39% for pneumonia and 18-61% for bacteremia, while these rates may be higher (40-70%) in case of MDR isolates [136][137][138]. In some age groups, these infections may have particularly severe manifestations (e.g., nosocomial pneumonia in the elderly, and severe sepsis and meningitis in neonates) [125][126][127][128][129][130][131][132][133][134][135][136][137]. The poor outcomes associated with these infections are corresponding to the severe condition of these patients and to the virulence factors of this pathogen.…”

Development of a Universal Fluorescent Probe for Gram‐Positive Bacteria

“…Finally, we applied 5 μ m BacGO to an infection model with Gram‐positive SA (8×10 8 cfu mL −1 ), which causes bacterial keratitis in humans . A Gram‐negative bacteria, PA (8×10 8 cfu mL −1 ), commonly found in contact lenses, was used as a negative control . After overnight inoculation in the scratched site, eye infection by PA resulted in inflammation, but the SA‐infection model did not show any symptoms.…”

Corneal Ring Abscess after Cardiac Surgery

“…He was treated with fortified tobramycin eye drops and parenteral ceftazidime. 2 Figure, B shows response to treatment with residual corneal scarring. Care of the eyes is often neglected when larger issues like cardiac dysfunction and sepsis dominate the clinical picture.…”