The successful treatment of a multidrug-resistantAchromobacter xylosoxidanscorneal ulcer with topical meropenem

Abstract

Microbial keratitis is a common corneal condition, with many known risk factors. We present a case of an 88-year-old female patient with a multidrug-resistant corneal ulcer in a previously failed second penetrating keratoplasty, successfully managed with topical meropenem drops administered hourly around the clock, for five days preceding and then hourly day only, for five days following a repeat third penetrating keratoplasty. Topical meropenem 50 mg/mL was prepared by mixing a 500 mg vial of meropenem with 10 mL of sterile water with pharmacy advice that administration should be within an hour. To the best of our knowledge, this is the first report of the use of topical meropenem in the management of keratitis. This case highlights the importance of the mean inhibitory concentrations for antibiotics when considering sensitivities. Topical meropenem may be a useful treatment option for multidrug-resistant bacterial corneal ulcers that are resistant to conventional therapy.

An 11-year analysis of microbial keratitis in the South West of England using brain–heart infusion broth

“…This is the expected response against concentrations of the antimicrobial agent achieved in the serum, which will be different to that achieved in the cornea and aqueous humour following topical application [17]. There is very-little pharmacokinetic/pharmacodynamic data available for topical antimicrobials, which may be significantly different to systemically administered drugs [18]. Our first-line treatment is monotherapy with levofloxacin 0.5% and second-line treatment is dual therapy with cefuroxime 5% and gentamicin 1.5%.…”

Achromobacter xylosoxidans as emerging pathogen in healthcare settings: A mini review

“…Total number of patients reported were 14, where most of them were reported survived [6, 15-17, 22, 24, 27-29]. Ocular-, pulmonary-, and cardio-related comorbidities were found in multiple cases [6,[15][16][17]29]. Interestingly, hyponatraemia was among the associated comorbidity [30].…”

“…The origin of the samples used for diagnosis varied across the studies, such as sputum [30], ear and/or lung swabs [15,22], lung tissue [15,29], and wounds [24]. The diagnostic tools used in the studies were culture-based methods [22,24,29], mass spectrometry [6], and molecular techniques such as polymerase chain reaction (PCR) and genome sequencing [21]. The infection can be treated successfully with antibiotics [6,15,17]; however, in others, the outcome may be fatal [16,30].…”

“…The diagnostic tools used in the studies were culture-based methods [22,24,29], mass spectrometry [6], and molecular techniques such as polymerase chain reaction (PCR) and genome sequencing [21]. The infection can be treated successfully with antibiotics [6,15,17]; however, in others, the outcome may be fatal [16,30].…”

“…A. xylosoxidans infections can range in severity, and the fatality of the disease can depend on several factors, including the type and severity of the infection, as well as the underlying health status of the affected individual [5,6]. Achromobacter infections tend to affect immunosuppressed patients, and A. xylosoxidans is particularly known for its ability to form Review Article biofilms, leading to chronic and recurrent infections [7,8].…”