title: Nocardia asteroides Keratitis Resistant to Amikacin.
abstract: OBJECTIVE
  To describe 2 cases of Nocardia keratitis resistant to topical compounded amikacin therapy.
  
  
  METHODS
  A 24-year-old woman presented with a corneal infiltrate. Cultures were taken, and topical moxifloxacin was administered. Corneal biopsy was performed when clinical status deteriorated, which confirmed infection with Nocardia. The patient was administered topical compounded amikacin. When clinical status further deteriorated, she was switched to compounded trimethoprim-sulfamethoxazole, which resulted in rapid resolution. Separately, a 22-year-old woman presented with contact lens-related keratitis that grew Nocardia asteroides. Corneal cultures and drug sensitivity testing revealed a strain of N. asteroides resistant to amikacin and imipenem, but sensitive to tobramycin. After a protracted clinical course, the keratitis ultimately responded to topical tobramycin leaving the patient with a pericentral corneal scar.
  
  
  CONCLUSIONS
  Nocardia keratitis is an atypical infection for which standard management algorithms exist. However, atypical cases require that these patients be followed closely for the response to therapy.
authors.affiliation: *Department of Ophthalmology, Penn State Hershey Medical Center, Hershey, PA; †Bascom Palmer Eye Institute, University of Miami, Miami, FL; and ‡Cullen Eye Institute, Baylor College of Medicine, Houston, TX.
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.forename: Adam
authors.initials: A
authors.lastname: Sise
authors.forename: Zaina
authors.initials: Z
authors.lastname: Al-Mohtaseb
authors.forename: Noel
authors.initials: N
authors.lastname: Garcia
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Guillermo
authors.initials: G
authors.lastname: Amescua
authors.forename: Seth M
authors.initials: SM
authors.lastname: Pantanelli
mesh_terms: D000287:Administration, Topical; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003263:Contact Lenses, Hydrophilic / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007613:Kanamycin Resistance; D008826:Microbial Sensitivity Tests; D009617:Nocardia Infections / Q000188:drug therapy / Q000382:microbiology*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D009883:Ophthalmic Solutions; D014031:Tobramycin / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D014031:Tobramycin