Use of topical colistin in bacterial keratitis caused by extensively drug-resistant Pseudomonas Aeruginosa: a case report

Abstract

Bacterial keratitis caused by multidrug-resistant strains of Pseudomonas aeruginosa is a therapeutic challenge due to a limited number of active antimicrobials and rapid progression to corneal necrosis and perforation. To report the use of topical colistin and surgical tarsorrhaphy in a case of keratitis caused by extensively drug-resistant Pseudomonas aeruginosa in a patient with severe coronavirus disease-2019 (COVID-19) pneumonia. A 56-year-old male was admitted to the intensive care unit with clinical symptoms of severe COVID-19 pneumonia. During his stay in the unit, he developed rapidly progressive keratitis with Pseudomonas aeruginosa resistant to all drugs except for colistin on culture. Due to incomplete lid closure, a temporary tarsorrhaphy was performed, and a regimen of descending-dose topical colistin was initiated. After five weeks, keratitis resolved completely. Extensively drug-resistant Pseudomonas aeruginosa is an unusual cause of bacterial keratitis. We describe the safe and effective use of topical colistin in a case with severe corneal involvement.

Cefiderocol Is an Effective Topical Monotherapy for Experimental Extensively Drug-Resistant Pseudomonas aeruginosa Keratitis

“…In 2 reports, topically applied colistin by itself or in combination with fortified tobramycin-soaked collagen shields was used and resolved the infections after close to 2 months of therapy. 32 , 33 In another paper, a patient was treated topically with polymyxin B/trimethoprim and imipenem-cilastatin, but the infection was not resolved during the 1 month course of the published study. 3 In another report, Morelli et al 2 used intravenous cefiderocol in combination with topical application of imipenem-cilastatin and polymyxin B/trimethoprim and oral doxycycline.…”

Cefiderocol is an effective topical monotherapy for experimental extensively-drug resistantPseudomonas aeruginosakeratitis

“…Several reports describe utilization of off label medications to attempt to control these aggressive infections. In two reports topically applied colistin by itself or in combination with fortified tobramycin-soaked collagen shields was used and resolved the infections after close to two months of therapy 28,29 .…”

“…Several reports describe utilization of off label medications to attempt to control these aggressive infections. In two reports topically applied colistin by itself or in combination with fortified tobramycin-soaked collagen shields was used and resolved the infections after close to two months of therapy 28, 29 . In another paper, a patient was treated topically with polymyxin B/trimethoprim and imipenem-cilastatin, but the infection was not resolved during the 1 month course of the published study 3 .…”