Clinical outcomes of corneal graft infections caused by multi-drug resistant Pseudomonas aeruginosa.
OBJECTIVE
The aim was to assess the clinical outcomes of corneal graft infections caused by multi-drug resistant Pseudomonas aeruginosa (MDR-PA).


METHODS
This is a retrospective case series of 38 patients with corneal graft infections caused by MDR-PA managed from June to December 2011. Clinical and demographic details, treatment outcome on primary therapy, cases requiring a repeat graft, their outcome, and recurrence rate on treatment were analyzed. The outcome measure was resolution of infection. Success was "complete" if resolution was seen without subsequent recurrence up to 2 weeks and "partial" if it required intervention such as cyanoacrylate glue application. It was a "failure" if the infection could not be controlled and the patient required a repeat graft or the eye had to be eviscerated.


RESULTS
Thirty-one patients were initially treated with topical cefazolin 5% and ciprofloxacin 0.3%, 6 with topical colistin 0.19%, and 1 was treated with topical imipenem 1%. On this treatment, 9 cases showed complete success and 6 showed partial success. Twenty-two patients required a repeat graft, and 1 eye was eviscerated. The patients with outcome of success had smaller graft infiltrates (median area = 2 mm; range = 1-24.6 mm vs. median infiltrate area = 24.8 mm; range = 1.5-64 mm) than those with an outcome of failure (P = 0.02). At the mean follow-up of 50 days, recurrence after the repeat surgery was seen in 4/22 (18.2%) patients.


CONCLUSIONS
Medical therapy can be tried in sensitive and smaller MDR-PA graft infiltrates, but larger infiltrates and those with endophthalmitis require early surgical intervention.
*Cornea and Anterior Segment Service, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and †Jhaveri Microbiology Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
Rajat
R
Jain
Somasheila I
SI
Murthy
Swapna Reddy
SR
Motukupally
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D024901:Drug Resistance, Multiple, Bacterial; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007634:Keratitis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology; D011552:Pseudomonas Infections / Q000382:microbiology* / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012008:Recurrence; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents