Clinical features, antibiotic sensitivity profiles and outcomes of infectious keratitis caused by Achromobacter xylosoxidans

Session Details

Session Title: Inflammation and Pathology

Session Date/Time: Sunday 11/09/2016 | 14:30-16:00

Paper Time: 14:30

Venue: Hall C2

First Author: : O.Spierer ISRAEL

Co Author(s): :    P. Monsalve   T. O'Brien   E. Alfonso   D. Gologorsky   D. Miller        

Abstract Details

Purpose:

Reports on Achromobacter xyloxosidans corneal infections are increasing, drawing attention to its emerging role in infectious keratitis. The purpose of this study is to develop a better understanding of the clinical features, antibiotic susceptibility profile, and treatment outcomes of infectious keratitis caused by A. xyloxosidans.

Setting:

A tertiary ophthalmology referral center in South Florida, USA.

Methods:

A microbiology database and clinical chart review was performed in 28 patients diagnosed with A. xylosoxidans keratitis at the Bascom Palmer Eye Institute between the years 1987 and 2014. Data was analyzed as to predisposing factors, vision at presentation and after treatment, antimicrobial susceptibilities, minimum inhibitory concentrations (MIC), treatment course and outcomes.

Results:

The main risk factors were contact lens wear (n=8, 28.6%) and corneal graft (n=8, 28.6%). On presentation, visual acuity was 20/100 or worse in 20 (71.2%) patients. In most cases, tobramycin or topical fluoroquinolones were the initial treatment, often accompanied by vancomycin. High susceptibility rates were found for ticarcillin (100%, MIC90=16) and piperacillin (100%, MIC90=8). Low susceptibility rates were documented for gentamicin (20%, MIC90=16), tobramycin (26.7%, MIC90=16) and ciprofloxacin (46.7%, MIC90=8). Six (21.4%) patients underwent therapeutic penetrating keratoplasty and 2 (7.1%) patients had conjunctival flap surgery. Visual acuity at final follow up was 20/100 or worse in 16 (57.1%) patients.

Conclusions:

This is the largest series of corneal ulcers caused by the opportunistic pathogen A. xylosoxidans. Infectious keratitis caused by this pathogen is associated with poor visual outcomes. For many ophthalmologists, fluoroquinolones and aminoglycosides are the first empirical treatment of choice for presumed bacterial keratitis. These antimicrobials are not an appropriate treatment for A. xyloxosidans keratitis. Further studies are needed in order to define the clinical application of compound piperacillin and ticarcillin eye drops.

Financial Disclosure:

NONE