Posters

Clinical features, antibiotic susceptibility profile, and outcomes of infectious keratitis caused by stenotrophomonas maltophilia

Poster Details

First Author: S. Palioura UNITED STATES

Co Author(s):    A. Gibbons   D. Miller   T. O'Brien   E. Alfonso   O. Spierer        

Abstract Details

Purpose:

To develop a better understanding of the clinical features, antibiotic susceptibility profile, and treatment outcomes of infectious keratitis caused by Stenotrophomonas maltophilia. Though uncommon, this aerobic gram-negative bacillus is particularly difficult to treat due to its resistance to multiple antibiotics.

Setting:

The Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, a tertiary ophthalmology referral center in South Florida, USA.

Methods:

A retrospective review of records from November 1989 to February 2014 identified 22 eyes of 22 patients who were treated at the Bascom Palmer Eye Institute for a corneal ulcer caused by S. maltophilia. Clinical data was analyzed as to predisposing factors, vision at presentation and after treatment, clinical presentation, antibiotic susceptibility, treatment selection and clinical outcomes.

Results:

Mean age at presentation was 66.2 ± 20.2 years. Nine patients (40.9%) were contact lens wearers and 5 (22.7%) had a history of penetrating keratoplasty. Vision at presentation ranged from 20/25 to no light perception. All patients received topical antibiotics, one required a therapeutic penetrating keratoplasty and one was enucleated. Final best-corrected vision ranged from 20/20 to no light perception. Nine patients (40.9%) had visual acuity 20/100 or worse at final visit. Nineteen of the 22 strain isolates (86.3%) were resistant to tobramycin and 18 (81.8%) to ceftazidime. Almost all isolates (20/22, 90.9%) were susceptible to the fluoroquinolones and to polymyxin/trimethoprim.

Conclusions:

This is the largest series of corneal ulcers due to the opportunistic pathogen S.maltophilia. Infectious keratitis due to S. maltophilia presents a treatment challenge due to its resistance to aminoglycosides and cephalosporins, which are typically used for empiric broad spectrum gram negative coverage as fortified solutions. Fluoroquinolones and polymyxin/trimethoprim should be used instead in cases of S. maltophilia infection.

Financial Disclosure:

NONE