Tavassoli Shokufeh, Gunn David, Williams O Martin, Darcy Kieren
Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK.
Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK.
BMJ Case Rep. 2018 Jul 18;2018:bcr-2018-225163. doi: 10.1136/bcr-2018-225163.
Microbial keratitis is a common corneal condition, with many known risk factors. We present a case of an 88-year-old female patient with a multidrug-resistant corneal ulcer in a previously failed second penetrating keratoplasty, successfully managed with topical meropenem drops administered hourly around the clock, for five days preceding and then hourly day only, for five days following a repeat third penetrating keratoplasty. Topical meropenem 50 mg/mL was prepared by mixing a 500 mg vial of meropenem with 10 mL of sterile water with pharmacy advice that administration should be within an hour. To the best of our knowledge, this is the first report of the use of topical meropenem in the management of keratitis. This case highlights the importance of the mean inhibitory concentrations for antibiotics when considering sensitivities. Topical meropenem may be a useful treatment option for multidrug-resistant bacterial corneal ulcers that are resistant to conventional therapy.
微生物性角膜炎是一种常见的角膜疾病，有许多已知的危险因素。我们报告一例88岁女性患者，在先前失败的第二次穿透性角膜移植术后发生耐多药角膜溃疡，在重复进行第三次穿透性角膜移植术前5天，每小时使用一次美罗培南滴眼液进行成功治疗，术后5天改为仅白天每小时一次。50mg/mL的美罗培南滴眼液是在药房建议下，将500mg美罗培南小瓶与10mL无菌水混合制备而成，建议在一小时内使用。据我们所知，这是首次报道使用局部美罗培南治疗角膜炎。该病例突出了在考虑敏感性时抗生素最低抑菌浓度的重要性。局部使用美罗培南可能是治疗对传统疗法耐药的耐多药细菌性角膜溃疡的一种有用选择。
