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）术后迟发性产酸克雷伯菌（Klebsiella oxytoca）性角膜炎及其治疗方案。1例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，出现左眼发红及渗液症状。检查可见其鼻上象限有单根缝线松动，且在该松动缝线对应的植片与植床交界处存在浸润灶及上皮缺损。临床予经验性每小时一次的高浓度万古霉素及头孢他啶滴眼液治疗，但患者症状改善不佳。对患者采集的眼拭子及缝线标本进行培养后，检出产酸克雷伯菌，遂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，患者眼部浸润灶迅速消退，上皮缺损得以闭合。高浓度亚胺培南可作为替代治疗方案，尤其适用于常规治疗无效且培养检出致病菌的病例。