Topical Piperacillin/Tazobactam for Recalcitrant <i>Pseudomonas Aeruginosa</i> Keratitis

Purpose:Extended-spectrum beta-lactamases (ESBLs) mediated resistance is more prevalent worldwide, especially among Gram-negative bacterial isolates, conferring resistance to the expanded spectrum cephalosporins. As limited data were available on the prevalence of ESBLs in this area, the current study was undertaken to determine the prevalence, antibacterial resistance patterns, and molecular detection and characterization of ESBL encoding resistance genes among ocular Gram-negative bacterial isolates from ocular infections.Materials and Methods:A prospective study was done on 252 ocular Gram-negative bacterial isolates recovered from ocular infections during a study period from February 2011 to January 2014. All isolates were subjected to detection of ESBLs by cephalosporin/clavulanate combination disc test and their antibacterial resistance pattern was studied. Molecular detection and characterization of ESBL encoding blaTEM-, blaSHV, blaOXA-, and blaCTX-M (phylogenetic groups 1, 2, 9, and 8/25) resistance genes by multiplex polymerase chain reaction and DNA sequence analysis.Results:Of all Gram-negative bacteria, Pseudomonas aeruginosa (44%) was the most common strain, followed by Enterobacter agglomerans and Klebsiella pneumoniae each (10%). Among the 252, 42 (17%) were ESBL producers. The major source of ESBL producers were corneal scraping specimens, highest ESBL production was observed in P. aeruginosa 16 (38%) and Escherichia coli 7 (16.6%). Among ESBL-producing genes, the prevalence of blaTEM-gene was the highest (83%) followed by blaOXA-gene (35%), blaSHV-gene (18.5%), and blaCTX-M-1-gene (18.5%) alone or together.Conclusion:The higher rate of prevalence of ESBLs-encoding genes among ocular Gram-negative bacteria is of great concern, as it causes limitation to therapeutic options. This regional knowledge will help in guiding appropriate antibiotic use which is highly warranted.

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“…Topical or intraocular piperacillin/tazobactam has been used for the treatment of such cases. [ 34 35 ]…”

Section: Discussionmentioning

confidence: 99%

Prevalence and antibacterial resistance patterns of extended-spectrum beta-lactamase producing Gram-negative bacteria isolated from ocular infections

Rameshkumar

Ramakrishnan

Shivkumar

et al. 2016

Indian J Ophthalmol

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“…[14][15][16] It is not uncommon to come across multidrug resistant P. aeruginosa isolates, especially in patients with keratitis and endophthalmitis. [17,18] Topical or intraocular piperacilin/tazobactum have been used for the treatment of such cases. [17,18] Fewer studies have reported the level of antibiotic resistance among Enterobacteriaceae isolated from eye infections.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

“…[17,18] Topical or intraocular piperacilin/tazobactum have been used for the treatment of such cases. [17,18] Fewer studies have reported the level of antibiotic resistance among Enterobacteriaceae isolated from eye infections. In one study, the resistance to gatifloxacin was 3.4%, to ofloxacin and ciprofloxacin was 5.1% and to gentamicin was 8.5%.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Antibiotic resistance in ocular bacterial pathogens

Sharma

2011

Indian Journal of Medical Microbiology

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Bacterial infections of the eye are common and ophthalmologists are spoilt for choice with a variety of antibiotics available in the market. Antibiotics can be administered in the eye by a number of routes; topical, subconjunctival, subtenon and intraocular. Apart from a gamut of eye drops available, ophthalmologists also have the option of preparing fortified eye drops from parenteral formulations, thereby, achieving high concentrations; often much above the minimum inhibitory concentration (MIC), of antibiotics in ocular tissues during therapy. Antibiotic resistance among ocular pathogens is increasing in parallel with the increase seen over the years in bacteria associated with systemic infections. Although it is believed that the rise in resistant ocular bacterial isolates is linked to the rise in resistant systemic pathogens, recent evidence has correlated the emergence of resistant bacteria in the eye to prior topical antibiotic therapy. One would like to believe that either of these contributes to the emergence of resistance to antibiotics among ocular pathogens. Until recently, ocular pathogens resistant to fluoroquinolones have been minimal but the pattern is currently alarming. The new 8-fluoroquinolone on the scene-besifloxacin, is developed exclusively for ophthalmic use and it is hoped that it will escape the selective pressure for resistance because of lack of systemic use. In addition to development of new antibacterial agents, the strategies to halt or control further development of resistant ocular pathogens should always include judicious use of antibiotics in the treatment of human, animal or plant diseases.

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“…18 Sometimes a combination of piperacillin/tazobactam might be effective with unresponsive P. aeruginosa MK. 52 …”

Section: Introductionmentioning

confidence: 99%

Management and treatment of contact lens-related Pseudomonas keratitis

Willcox¹

2012

OPTH

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Pubmed and Medline were searched for articles referring to Pseudomonas keratitis between the years 2007 and 2012 to obtain an overview of the current state of this disease. Keyword searches used the terms “Pseudomonas” + “Keratitis” limit to “2007–2012”, and [“Ulcerative” or “Microbial”] + “Keratitis” + “Contact lenses” limit to “2007–2012”. These articles were then reviewed for information on the percentage of microbial keratitis cases associated with contact lens wear, the frequency of Pseudomonas sp. as a causative agent of microbial keratitis around the world, the most common therapies to treat Pseudomonas keratitis, and the sensitivity of isolates of Pseudomonas to commonly prescribed antibiotics. The percentage of microbial keratitis associated with contact lens wear ranged from 0% in a study from Nepal to 54.5% from Japan. These differences may be due in part to different frequencies of contact lens wear. The frequency of Pseudomonas sp. as a causative agent of keratitis ranged from 1% in Japan to over 50% in studies from India, Malaysia, and Thailand. The most commonly reported agents used to treat Pseudomonas keratitis were either aminoglycoside (usually gentamicin) fortified with a cephalosporin, or monotherapy with a fluoroquinolone (usually ciprofloxacin). In most geographical areas, most strains of Pseudomonas sp. (≥95%) were sensitive to ciprofloxacin, but reports from India, Nigeria, and Thailand reported sensitivity to this antibiotic and similar fluoroquinolones of between 76% and 90%.

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Topical Piperacillin/Tazobactam for Recalcitrant Pseudomonas Aeruginosa Keratitis

Abstract: Therapy-resistant P. aeruginosa keratitis acquired from the community is becoming an increasing problem. Topical piperacillin/tazobactam is an option for the treatment of therapy-resistant P. aeruginosa keratitis.

Cited by 16 publications

References 8 publications

Prevalence and antibacterial resistance patterns of extended-spectrum beta-lactamase producing Gram-negative bacteria isolated from ocular infections

Prevalence and antibacterial resistance patterns of extended-spectrum beta-lactamase producing Gram-negative bacteria isolated from ocular infections

Antibiotic resistance in ocular bacterial pathogens

Management and treatment of contact lens-related Pseudomonas keratitis

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