title: Fourth-generation fluoroquinolone-resistant mycobacterial keratitis after laser in situ keratomileusis.
abstract: We report a case of mycobacterial keratitis resistant to fourth-generation fluoroquinolones after laser in situ keratomileusis (LASIK) with fourth-generation fluoroquinolone prophylaxis. While receiving moxifloxacin post LASIK, the patient was diagnosed with moxifloxacin-resistant Mycobacterium chelonae keratitis. Culture susceptibilities revealed isolates resistant to moxifloxacin and gatifloxacin, and treatment with topical amikacin and clarithromycin with oral doxycycline and clarithromycin along with flap amputation was necessary to control the infection. This case demonstrates the potential limitations in the coverage of these antibiotic agents.
authors.affiliation: John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84121, USA. Majid.Moshirfar@hsc.utah.edu
authors.forename: Majid
authors.initials: M
authors.lastname: Moshirfar
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Meyer
authors.forename: Ladan
authors.initials: L
authors.lastname: Espandar
mesh_terms: D000328:Adult; D000583:Amikacin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D004318:Doxycycline / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D000077734:Gatifloxacin; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000382:microbiology*; D016926:Mycobacterium chelonae / Q000187:drug effects / Q000302:isolation & purification*; D011804:Quinolines / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000583:Amikacin; D017291:Clarithromycin; D000077734:Gatifloxacin; D004318:Doxycycline; D000077266:Moxifloxacin