Johnson J L, Sagraves S G, Feild C J, Block E F, Cheatham M L
Department of Surgical Education, Orlando Regional Medical Center, Florida, USA.
Am Surg. 2000 Oct;66(10):972-4.
We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.
我们报告了1例在我们重症监护病房的创伤患者中，由铜绿假单胞菌引起的细菌性角膜炎继发角膜穿孔的病例。一名43岁男性遭遇摩托车车祸，多处受伤，需要在重症监护病房（ICU）长期住院。随后，在他的痰液、血液和开放性腹部培养出了铜绿假单胞菌。他右眼发生了细菌性角膜炎，培养结果也为铜绿假单胞菌。这种感染迅速发展为角膜穿孔，除积极的抗生素治疗外，还需要行冈德森结膜瓣和外侧睑裂缝合术。出院时，患者仅右眼恢复了光感视力。角膜穿孔在ICU中是不常见的事件。需要通过积极的抗生素治疗预防或早期发现细菌性角膜炎，以防止此类并发症。铜绿假单胞菌是可感染角膜的毒性较强的病原体之一，早期识别对于取得良好预后至关重要。本文讨论了该复杂病例的处理方法，并综述了关于ICU医院获得性细菌性角膜炎的有限文献。
