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：由铜绿假单胞菌（Pseudomonas aeruginosa）多重耐药（multidrug-resistant）菌株引发的细菌性角膜炎（Bacterial keratitis），因可选用的有效抗菌药物极为有限，且病情可快速进展至角膜坏死与穿孔，是临床治疗的棘手难题。本文报告1例新型冠状病毒肺炎（coronavirus disease-2019, COVID-19）重症肺炎患者并发泛耐药（extensively drug-resistant）铜绿假单胞菌性角膜炎的诊疗经过，患者接受了局部应用黏菌素（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）。住院期间出现快速进展性角膜炎，病原学培养结果显示致病菌为铜绿假单胞菌，仅对黏菌素敏感。因患者存在眼睑闭合不全，遂行暂时性睑缘缝合术，并启动递减剂量的局部黏菌素治疗方案。治疗5周后，角膜炎完全消退。泛耐药铜绿假单胞菌引发细菌性角膜炎较为罕见。本文报道了该例角膜受累严重的患者，局部应用黏菌素治疗安全且有效。