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      Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia

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          Abstract

          Purpose

          Stenotrophomonas maltophilia, an uncommon cause of infectious keratitis, is difficult to treat due to its resistance to multiple antibiotics. The purpose of this study is to describe the clinical features, antibiotic susceptibility profile, and outcomes of S. maltophilia keratitis.

          Methods

          A retrospective review of records from 1987–2014 identified 26 eyes of 26 patients who were treated at the Bascom Palmer Eye Institute for a S. maltophilia corneal ulcer. Clinical data was analyzed as to predisposing factors, clinical presentation, antibiotic susceptibility, treatment selection and clinical outcomes.

          Results

          Median age at presentation was 64.9 years (range, 16.0 – 97.7). Twelve patients were using topical corticosteroids, 8 patients had a history of penetrating keratoplasty and 9 were contact lens wearers. All patients received topical antibiotics, two required a therapeutic penetrating keratoplasty, and one was enucleated. At presentation, 57.7% (15/26) of the patients had visual acuity 20/400 or worse. At the final visit only 30.4% (7/23) of the patients had visual acuity worse than 20/400, while 65.2% (15/23) of the patients were at 20/100 or better. Almost all isolates (25/26, 96.2%) were susceptible to fluoroquinolones and 77.3% (17/22) of them to polymyxin B/trimethoprim. Only 33.3% (5/15) of the tested isolates were susceptible to aminoglycosides and 58.3% (7/12) to cephalosporins.

          Conclusion

          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 B/trimethoprim should be considered instead in cases of S. maltophilia infection.

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          Author and article information

          Journal
          8216186
          3186
          Cornea
          Cornea
          Cornea
          0277-3740
          1536-4798
          2 November 2017
          March 2018
          01 March 2019
          : 37
          : 3
          : 326-330
          Affiliations
          [1 ]Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
          [2 ]Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
          Author notes
          Corresponding author address: Sotiria Palioura, MD, PhD. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida, 33136, USA; sotiria.palioura@ 123456gmail.com
          Article
          PMC5806132 PMC5806132 5806132 nihpa916881
          10.1097/ICO.0000000000001486
          5806132
          29408828
          162b3828-f727-46ed-b03d-c1895eda95fd
          History
          Categories
          Article

          Pseudomonas aeuroginosa , Stenotrophomonas maltophilia ,infectious keratitis,fluoroquinolones,antimicrobial susceptibility,aminoglycosides

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