A case of late-onset Klebsiella oxytoca keratitis treated with topical imipenem after deep anterior lamellar keratoplasty

ABSTRACT The aim of this study was to discuss a case of late-onset Klebsiella oxytoca keratitis after deep anterior lamellar keratoplasty and its treatment. A 21-year-old female patient presented with redness and effluence in the left eye at 5 months after uncomplicated deep anterior lamellar keratoplasty surgery. In the examination, a single suture was loosened in the superior nasal region and there was an infiltration area and epithelial defect in the graft and recipient bed junction in the area of the loose suture. Topical fortified vancomycin and fortified ceftazidime treatment was started empirically hourly, but there was insufficient response. After K. Oxytoca growth in a swab and suture culture taken from the patient, fortified vancomycin was replaced with fortified imipenem. It was observed that the infiltration area rapidly regressed and the epithelial defect was closed after fortified imipenem treatment. Fortified imipenem may be considered as an alternative treatment, especially in cases in which there is no response to treatment and culture growth is detected.

摘要 本研究旨在探讨1例单纯性深板层角膜移植术（deep anterior lamellar keratoplasty）后迟发性产酸克雷伯菌（Klebsiella oxytoca）性角膜炎的病例及其治疗方案。一名21岁女性患者在接受无并发症的深板层角膜移植术后5个月，出现左眼发红与溢液症状。检查可见其鼻上象限有单根缝线松动，且在缝线松动区域的植片与受体植床交界处存在浸润灶及上皮缺损。遂予经验性每小时一次的高浓度万古霉素与头孢他啶滴眼治疗，但疗效不佳。从患者处采集的拭子及缝线培养结果显示产酸克雷伯菌生长后，将高浓度万古霉素更换为高浓度亚胺培南。经高浓度亚胺培南治疗后，可见浸润灶迅速消退，上皮缺损得以闭合。高浓度亚胺培南可作为备选治疗方案，尤其适用于经初始治疗无效且培养检出致病菌的病例。