*Cornea and Anterior Segment Services, L V Prasad Eye Institute, Bhubaneswar, India; †Cornea and Anterior Segment Services; and ‡Jhaveri Ocular Microbiology Services, L V Prasad Eye Institute, Hyderabad, India.
Cornea. 2014 Sep;33(9):923-7. doi: 10.1097/ICO.0000000000000184.
The aim of this study was to report the utility of topical colistin in multi-drug resistant Pseudomonas aeruginosa bacterial keratitis.
Retrospective interventional case series included 8 patients with culture-proven multi-drug resistant P. aeruginosa (MDR-PA) bacterial keratitis who presented from June 2011 to January 2012 and were treated with colistin 0.19% as monodrug therapy. Clinical/microbiological data were collected from medical records. All patients underwent microbiological corneal scraping. Intensive half-hourly therapy with broad-spectrum antibiotics was changed to colistin 0.19% when antibiotic sensitivity reports were available. The outcome was a "complete success" if resolution of infection occurred with scar formation without any subsequent recurrence up to 2 weeks and "partial success" if it also required a cyanacrylate glue application. The outcome was a "failure" if the patient required a therapeutic graft or if the infection could not be controlled and the eye needed evisceration.
The mean age was 45 ± 16 years; the M:F ratio was 1:1. Seven patients had a history of ocular surgery. The mean size of the infiltrate was 15.41 ± 22.2 mm and was full thickness in 5 patients. Success was achieved in 7 out of 8 patients, and the infiltrate gradually decreased with resolution of infection in a mean duration of 30.5 ± 16 days. Complete and partial success were noted in 4 and 3 patients, respectively. The final visual acuity was 20/60 or better in 4 patients. One patient required a sclerocorneal patch graft. No complications of topical colistin were noticed.
The early use of topical colistin 0.19% was found to be a safe and effective alternative in the management of multi-drug resistant P. aeruginosa bacterial keratitis.
本研究旨在报告局部应用黏菌素治疗多重耐药铜绿假单胞菌细菌性角膜炎的效果。
回顾性干预病例系列研究纳入了 8 例 2011 年 6 月至 2012 年 1 月期间就诊的、培养证实为多重耐药铜绿假单胞菌（MDR-PA）细菌性角膜炎的患者，这些患者接受了黏菌素 0.19%作为单一药物治疗。从病历中收集临床/微生物学数据。所有患者均接受了微生物角膜刮片。当获得抗生素药敏报告时，将强化每半小时一次的广谱抗生素治疗改为黏菌素 0.19%。如果感染得到控制并形成瘢痕，且在接下来的 2 周内没有复发，则认为结局为“完全成功”；如果还需要氰基丙烯酸酯胶应用，则认为结局为“部分成功”。如果患者需要治疗性移植或感染无法控制且需要眼球摘除，则认为结局为“失败”。
患者的平均年龄为 45 ± 16 岁；男女比例为 1:1。7 例患者有眼部手术史。浸润的平均大小为 15.41 ± 22.2mm，5 例为全层浸润。8 例患者中有 7 例治疗成功，感染得到控制，浸润逐渐减少，平均持续时间为 30.5 ± 16 天。4 例患者完全成功，3 例患者部分成功。4 例患者最终视力达到 20/60 或更好。1 例患者需要进行板层巩膜移植。未发现局部应用黏菌素的并发症。
早期使用黏菌素 0.19%滴眼剂是治疗多重耐药铜绿假单胞菌细菌性角膜炎的一种安全有效的方法。
