Multiple drug-resistant Alcaligenes xylosoxidans keratitis in a sanitation worker.
OBJECTIVE
To report a case of daily wear soft contact lens-associated keratitis caused by Alcaligenes xylosoxidans in a portable toilet sanitation worker.


METHODS
A previously healthy 30-year-old man presented with bilateral decreased vision, redness, and irritation, beginning 1 week earlier. The patient had been treated with moxifloxocin for 1 week before presentation without improvement. Bacterial staining cultures were performed from corneal scrapings, contact lenses, contact lens case, and solution. Preliminary culture results and antibiotic sensitivities were generated using an automated identification system. Positive results from the contact lens, case, and solution were confirmed using polymerase chain reaction (PCR).


RESULTS
The contact lenses, contact lens case, and solution cultures revealed heavy growth of A. xylosoxidans. These findings were confirmed by PCR. The organism was found to be resistant to aminoglycosides, fluoroquinolones, and cephalosporins. The patient was started on polymyxin B or trimethoprim. After 21 days of treatment, the infection completely resolved with a final spectacle-corrected visual acuity of 20/25.


CONCLUSIONS
To our knowledge, this is the first case report of a corneal infection caused by A. xylosoxidans, which was isolated and identified from a contact lens, case, and solution using culture and PCR technique as well the first description of ocular surface disease resolution after the treatment with topical polymyxin B or trimethoprim. A. xylosoxidans should be considered as uncommon but potential pathogen capable of infectious spread through contaminated contact lens solution.
Kiernan
Daniel F
DF
Department of Ophthalmology and Visual Science, University of Chicago, IL 60637, USA.
Chin
Eric K
EK
Sclafani
Louise A
LA
Saidel
Michael A
MA
D042441:Achromobacter denitrificans / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology*; D000287:Administration, Topical; D000328:Adult; D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002511:Cephalosporins / Q000494:pharmacology; D018639:Contact Lens Solutions; D003261:Contact Lenses / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D015818:Eye Infections, Bacterial / Q000188:drug therapy; D024841:Fluoroquinolones / Q000494:pharmacology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D007634:Keratitis / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D009784:Occupational Diseases; D011113:Polymyxins / Q000008:administration & dosage; D012499:Sanitation; D014038:Toilet Facilities; D016896:Treatment Outcome; D014295:Trimethoprim / Q000008:administration & dosage
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018639:Contact Lens Solutions; D024841:Fluoroquinolones; D011113:Polymyxins; D014295:Trimethoprim