Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Eye (Lond). 2009 Feb;23(2):477-9. doi: 10.1038/eye.2008.290. Epub 2008 Sep 26.
To report a five case of secondary pseudomonas infection of fungal keratitis following use of contaminated natamycin eye drops.
A retrospective analysis of the course and clinical outcomes of five eyes of five patients with clinical and laboratory-confirmed fungal keratitis species was performed. Clinical worsening despite hourly topical 5% natamycin drops prompted a repeat corneal scraping and microbiological evaluation.
The causative fungi for the initial keratitis were Fusarium and Aspergillus species. All the five specimens obtained from repeat scrapings revealed Pseudomonas aeruginosa. The cultures obtained from the natamycin eye drops being used by the patients also grew pseudomonas. On further evaluation, the source of contamination of the natamycin containers was obscure but speculated to be nosocomial, being within the hospital or the pharmacy. All patients had a poor visual outcome with one requiring evisceration because of panophthalmitis, whereas three underwent therapeutic keratoplasty.
A high index of suspicion is recommended in all cases of worsening fungal keratitis to identify secondary contamination of antifungal agents with nosocomial infections.
报告 5 例使用污染的那他霉素滴眼液后真菌性角膜炎继发假单胞菌感染。
对 5 例经临床和实验室确诊的真菌性角膜炎患者 5 只眼的病程和临床转归进行回顾性分析。尽管每小时滴 5%那他霉素滴眼液，但临床病情恶化，提示重复角膜刮片和微生物评估。
初始角膜炎的致病真菌为镰刀菌属和曲霉菌属。从重复刮片中获得的 5 个标本均显示铜绿假单胞菌。从患者使用的那他霉素滴眼液中获得的培养物也生长出假单胞菌。进一步评估表明，那他霉素容器污染的来源不明，但推测为医院内或药房内的医院获得性感染。所有患者视力预后不良，1 例因全眼炎而行眼内容剜除术，3 例行治疗性角膜移植术。
对于所有真菌性角膜炎恶化的病例，建议高度怀疑是否存在抗真菌药物继发的医院感染污染。
