Oral moxifloxacin and topical amikacin for Mycobacterium abscessus keratitis after laser in situ keratomileusis

Abstract

We report a case of Mycobacterium abscessus keratitis after elective laser in situ keratomileusis in a 19-year-old woman. The infection started 3 weeks after uneventful surgery, and the patient received multiple antimicrobial treatments without response. A corneal scrape isolate showed an acid-fast bacterium that was subsequently confirmed by culture to be M abscessus. Prompt treatment of oral moxifloxacin 400 mg twice daily and hourly topical amikacin 2.5% was started. Recovery occurred within the first week of treatment, with complete resolution 3 weeks after presentation. The final uncorrected distance visual acuity was 6/9. We comment on other reports of post-LASIK keratitis caused by M abscessus, the in vitro sensitivity to antibiotic agents described in the literature, and the use of oral moxifloxacin as a potential good alternative treatment based on its good ocular bioavailability, which in our case allowed resolution without the need for surgical intervention.

Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

“…Examples of organisms wrongly determined to have caused the infection are Nocardia species [ 35 , 36 , 70 , 71 , 128 , 177 ] as well as Corynebacterium species [ 74 ]. Some examples of the incorrect diagnoses made were herpes keratitis [ 46 , 50 , 53 , 55 , 66 ] and fungal keratitis [ 39 , 46 , 48 , 54 , 94 ]. An orbital infection was confused for pseudotumor [ 11 ].…”

Activities of Moxifloxacin in Combination with Macrolides against Clinical Isolates of Mycobacterium abscessus and Mycobacterium massiliense

“…A recent prospective observational study demonstrated that CLR-MXF combination therapy for postacupuncture cutaneous M. abscessus infections resulted in a more rapid resolution of the cutaneous lesions than did the use of a CLR-amikacin combination (9). Moreover, MXF has been shown to be effective against experimentally induced M. abscessus keratitis and in human cases of that disorder (7,10,37). However, MXF obviously interferes with CLR activity in over 65% of the tested strains of M. abscessus in our models, indicating that many factors should be considered in explaining such a different result.…”

Opções farmacológicas para ceratite por micobactérias não-tuberculosas: uma revisão integrativa

“…Todos eles sofreram algum trauma corneano, controlado (cirúrgico) ou não. Um passou por uma cirurgia refrativa, chamada ceratomileuse assistida por excimer laser in situ (LASIK) 8 . Um foi submetido por um tipo de transplante de córnea total, chamado ceratoplastia penetrante (PKP) 7 .…”