title: Secondary pseudomonas infection of fungal keratitis following use of contaminated natamycin eye drops: a case series.
abstract: OBJECTIVE
  To report a five case of secondary pseudomonas infection of fungal keratitis following use of contaminated natamycin eye drops.
  
  
  METHODS
  A retrospective analysis of the course and clinical outcomes of five eyes of five patients with clinical and laboratory-confirmed fungal keratitis species was performed. Clinical worsening despite hourly topical 5% natamycin drops prompted a repeat corneal scraping and microbiological evaluation.
  
  
  RESULTS
  The causative fungi for the initial keratitis were Fusarium and Aspergillus species. All the five specimens obtained from repeat scrapings revealed Pseudomonas aeruginosa. The cultures obtained from the natamycin eye drops being used by the patients also grew pseudomonas. On further evaluation, the source of contamination of the natamycin containers was obscure but speculated to be nosocomial, being within the hospital or the pharmacy. All patients had a poor visual outcome with one requiring evisceration because of panophthalmitis, whereas three underwent therapeutic keratoplasty.
  
  
  CONCLUSIONS
  A high index of suspicion is recommended in all cases of worsening fungal keratitis to identify secondary contamination of antifungal agents with nosocomial infections.
authors.affiliation: Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. tiru@pondy.aravind.org
authors.forename: T
authors.initials: T
authors.lastname: Krishnan
authors.forename: S
authors.initials: S
authors.lastname: Sengupta
authors.forename: P R
authors.initials: PR
authors.lastname: Reddy
authors.forename: R D
authors.initials: RD
authors.lastname: Ravindran
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D004340:Drug Contamination; D015821:Eye Infections, Fungal / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007634:Keratitis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010866:Natamycin / Q000627:therapeutic use*; D009883:Ophthalmic Solutions; D011552:Pseudomonas Infections / Q000209:etiology*; D011550:Pseudomonas aeruginosa
chemical_list: D000935:Antifungal Agents; D009883:Ophthalmic Solutions; D010866:Natamycin