Successful use of intravitreal and systemic colistin in treating multidrug resistant Pseudomonas aeruginosa post-operative endophthalmitis

Abstract

We report a case series of post-operative endophthalmitis due to Pseudomonas aeruginosa. A total of 8 patients operated for cataract, were referred to our facility with acute onset of decreased vision 1-2 days following surgery. All patients had clinical evidence of acute exogenous endophthalmitis with severe anterior chamber exudative reaction. Ocular samples (aqueous aspirate and vitreous tap) for microbiology were taken from all eyes. Microbiology from all revealed P. aeruginosa which was resistant to all antibiotics except colistin. With prompt and accurate microbiological support it was possible to control the infection in all the eyes with the use of colistin intravitreally and intravenously which to the best of our knowledge, has been never reported. Intravitreal injection of colistin could be an option effective in the management of multi-drug-resistant endophthalmitis caused by Gram-negative bacteria.

Multidrug-Resistant Pseudomonas aeruginosa Keratitis

“…In the absence of development of newer antimicrobials and increasing drug resistance, there has been a resurgence in the use of older drugs such as colistin in treating MDR-PA infections. 16 Colistin recently was reported to treat successfully some cases of keratitis and endophthalmitis resulting from MDR-PA. 9,17 However, neither imipenem nor colistin is available as a topical formulation for ocular application, and both have to be compounded from formulations meant for intravenous use. This, and the relatively high costs of these drugs, are the main concerns limiting their use.…”

Prevalence and Possible Predictors of Drug-Resistant Pseudomonas aeruginosa in External Ocular Infections: A Single-Center, Retrospective, Cross-Sectional Study

“…In spite of the high susceptibility of these bacteria to colistin, it has not been used widely since the early 1980s mainly because of its nephrotoxicity and the subsequent emergence of other broad-spectrum antimicrobials [15]. Later, in addition to its use against gram-negative rods including MDRP in systemic disorders, colistin was refocused as an antimicrobial against MDRP in ocular infections [8,10,11,16].…”

“…In terms of ocular infections, P. aeruginosa can cause conditions such as keratitis and endophthalmitis [6,7]. Although ocular MDRP infections have been reported in recent years, only a few studies have investigated focal risk factors for these ocular infections [8][9][10].…”

Management of multi drug resistant endogenous Klebsiella pneumoniae endophthalmitis with intravitreal and systemic colistin

“…All of the eyes could be salvaged. [ 7 ] Taneja et al . also reported successful use of intravitreal colistin combined with multiple vitrectomies for managing postendothelial keratoplasty endophthalmitis due to MDR KP.…”