title: Treatment of multidrug-resistant Flavobacterium indologenes keratitis with trimethoprim-sulfamethoxazole.
abstract: OBJECTIVE
  To describe the history, clinical presentation, and successful medical management of a case of multidrug-resistant Flavobacterium indologenes keratitis.
  
  
  METHODS
  An 83-year-old pseudophakic female presented with a 2-day history of decreased visual acuity, light sensitivity and dull ocular pain in her right eye. Two weeks before presentation, the patient had been treated for a red eye with combination topical loteprednol etabonate (0.5%) and tobramycin (0.3%) eye drops. Corneal scrappings were performed by the referring ophthalmologist, and hourly administration of gatifloxacin 0.3% eye drops was started. Evaluation consisted of slit lamp examination, organism identification, and antibiotic sensitivity testing.
  
  
  RESULTS
  Examination of the right eye revealed a central 5-mm X 2-mm anterior stromal infiltrate with an overlying epithelial defect. Gatifloxacin 0.3% eye drops were stopped, and hourly topical fortified vancomycin (50 mg/mL) and ceftazidime (50 mg/mL) eye drops were instituted. Oxidase-positive gram-negative bacilli were identified in the thioglycollate broth on day 3, and therefore, vancomycin was discontinued and hourly ciprofloxacin 0.3% eye drops were added to the regimen. The cultures ultimately grew F. indologenes, which was highly resistant to all antibiotics tested except for trimethoprim-sulfamethoxazole. Accordingly, ciprofloxacin 0.3% and ceftazidime were discontinued. The patient was started on hourly topical trimethoprim (16 mg/mL)/sulfamethoxazole (80 mg/mL) eye drops, resulting in clinical control of the infection over a period of 1 month.
  
  
  CONCLUSIONS
  Flavobacterium indologenes keratitis can be resistant to treatment with many medications, and antibiotic susceptibility profile testing in these cases may provide crucial information to help eradicate the infection.
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Ramos-Esteban
authors.forename: Sonya
authors.initials: S
authors.lastname: Bamba
authors.forename: Bennie H
authors.initials: BH
authors.lastname: Jeng
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D045826:Flavobacteriaceae Infections / Q000188:drug therapy*; D005417:Flavobacterium / Q000502:physiology*; D006801:Humans; D007634:Keratitis / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014792:Visual Acuity
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination