title: Use of topical colistin in multiple drug-resistant Pseudomonas aeruginosa bacterial keratitis.
abstract: OBJECTIVE
  The aim of this study was to report the utility of topical colistin in multi-drug resistant Pseudomonas aeruginosa bacterial keratitis.
  
  
  METHODS
  Retrospective interventional case series included 8 patients with culture-proven multi-drug resistant P. aeruginosa (MDR-PA) bacterial keratitis who presented from June 2011 to January 2012 and were treated with colistin 0.19% as monodrug therapy. Clinical/microbiological data were collected from medical records. All patients underwent microbiological corneal scraping. Intensive half-hourly therapy with broad-spectrum antibiotics was changed to colistin 0.19% when antibiotic sensitivity reports were available. The outcome was a "complete success" if resolution of infection occurred with scar formation without any subsequent recurrence up to 2 weeks and "partial success" if it also required a cyanacrylate glue application. The outcome was a "failure" if the patient required a therapeutic graft or if the infection could not be controlled and the eye needed evisceration.
  
  
  RESULTS
  The mean age was 45 ± 16 years; the M:F ratio was 1:1. Seven patients had a history of ocular surgery. The mean size of the infiltrate was 15.41 ± 22.2 mm and was full thickness in 5 patients. Success was achieved in 7 out of 8 patients, and the infiltrate gradually decreased with resolution of infection in a mean duration of 30.5 ± 16 days. Complete and partial success were noted in 4 and 3 patients, respectively. The final visual acuity was 20/60 or better in 4 patients. One patient required a sclerocorneal patch graft. No complications of topical colistin were noticed.
  
  
  CONCLUSIONS
  The early use of topical colistin 0.19% was found to be a safe and effective alternative in the management of multi-drug resistant P. aeruginosa bacterial keratitis.
authors.affiliation: *Cornea and Anterior Segment Services, L V Prasad Eye Institute, Bhubaneswar, India; †Cornea and Anterior Segment Services; and ‡Jhaveri Ocular Microbiology Services, L V Prasad Eye Institute, Hyderabad, India.
authors.forename: Rajat
authors.initials: R
authors.lastname: Jain
authors.forename: Somasheila I
authors.initials: SI
authors.lastname: Murthy
authors.forename: Swapna R
authors.initials: SR
authors.lastname: Motukupally
authors.forename: Mitesh
authors.initials: M
authors.lastname: Jain
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010865:Pilot Projects; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D003091:Colistin