CASE REPORT: Multidrug-resistant Pseudomonas keratitis and sequential endophthalmitis treated with chlorhexidine and piperacillin-tazobactam

Purpose To report the clinical course and treatment strategies employed in management of a case multidrug-resistant Pseudomonas aeruginosa keratitis progressing to endophthalmitis. The drug-resistant strain was later traced use contaminated EzriCare Artificial Tears multi-state cluster outbreak. Observations A 57-year-old male patient with history Descemet stripping automated endothelial keratoplasty referred for culture-positive corneal ulcer right eye that had been treated several weeks topical moxifloxacin, fortified vancomycin tobramycin, intravitreal injections His cornea cultured off antibiotics grew only rare Propionibacterium acnes. Topical steroids were reduced, but his condition rapidly deteriorated leading melt, perforation, Repeat cultures sensitivity analyses revealed growth resistant fluoroquinolones, aminoglycosides, cephalosporins, monobactams, carbapenems, intermediate susceptibility piperacillin-tazobactam. underwent therapeutic penetrating subsequently initiated on an intensive regimen chlorhexidine polymyxin-B/trimethoprim. He also pars plana vitrectomy anterior chamber washout, followed by serial piperacillin-tazobactam at dose 225 mg/0.1 mL. After 8 treatment, there gradual healing ocular surface, regression hypopyon posterior inflammation, no signs recurrent infection. public health investigation ultimately infection one cases involved multistate outbreak extensively infections Tears. Conclusions Importance Multidrug-resistant endophthalmitis caused requires consideration nonconventional antimicrobial agents experimental alternatives. are currently therapies context bacterial endophthalmitis, safe effective