Use of topical colistin in bacterial keratitis caused by extensively drug-resistant Pseudomonas Aeruginosa: a case report

ABSTRACT Bacterial keratitis caused by multidrug-resistant strains of Pseudomonas aeruginosa is a therapeutic challenge due to a limited number of active antimicrobials and rapid progression to corneal necrosis and perforation. To report the use of topical colistin and surgical tarsorrhaphy in a case of keratitis caused by extensively drug-resistant Pseudomonas aeruginosa in a patient with severe coronavirus disease-2019 (COVID-19) pneumonia. A 56-year-old male was admitted to the intensive care unit with clinical symptoms of severe COVID-19 pneumonia. During his stay in the unit, he developed rapidly progressive keratitis with Pseudomonas aeruginosa resistant to all drugs except for colistin on culture. Due to incomplete lid closure, a temporary tarsorrhaphy was performed, and a regimen of descending-dose topical colistin was initiated. After five weeks, keratitis resolved completely. Extensively drug-resistant Pseudomonas aeruginosa is an unusual cause of bacterial keratitis. We describe the safe and effective use of topical colistin in a case with severe corneal involvement.

【摘要】由多重耐药（multidrug-resistant）铜绿假单胞菌（Pseudomonas aeruginosa）引发的细菌性角膜炎，因有效抗菌药物选择有限，且病情可快速进展至角膜坏死与穿孔，成为临床治疗难题。本文报告1例新型冠状病毒肺炎（COVID-19）重症肺炎患者并发泛耐药（extensively drug-resistant, XDR）铜绿假单胞菌角膜炎的诊疗经过，患者接受局部粘菌素（topical colistin）联合手术睑缘缝合术（surgical tarsorrhaphy）的治疗方案。患者为56岁男性，因重症COVID-19肺炎收入重症监护病房（intensive care unit, ICU）。住院期间，其出现快速进展性角膜炎，病原学培养结果显示该菌株对除粘菌素外的所有抗菌药物均耐药。鉴于患者存在眼睑闭合不全，遂行暂时性睑缘缝合术，并启动递减剂量局部粘菌素治疗方案。治疗5周后，角膜炎完全消退。泛耐药铜绿假单胞菌所致细菌性角膜炎较为罕见，本文详述了该例伴严重角膜受累患者安全、有效应用局部粘菌素的临床实践。