Multi-drug resistant  Enterococcus faecium  in late-onset keratitis after deep anterior lamellar keratoplasty

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Abstract

Rationale:

Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature.

Patient concerns:

A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus.

Diagnoses:

Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface.

Interventions:

Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days.

Outcomes:

During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively.

Lessons:

Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.

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Most cited references 21

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Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce?

Roland Leclercq, Vincent Cattoir (2013)

Twenty-five years ago, isolation of vancomycin-resistant Enterococcus faecium (VREm) was reported both in the UK and in France. Since then, VREm has spread worldwide in hospitals. Hospital outbreaks appeared to be related to the evolution since the end of 1980s of a subpopulation of E. faecium highly resistant to ampicillin and fluoroquinolones (the so-called clonal complex CC17) that later acquired resistance to vancomycin. CC17 isolates are presumably better adapted than other E. faecium isolates to the constraints of the hospital environment and most contain mobile genetic elements, phage genes, genes encoding membrane proteins, regulatory genes, a putative pathogenicity island and megaplasmids. Colonization and persistence are major features of VREm. Inherent characteristics of E. faecium including a remarkable genome plasticity, in part due to acquisition of IS elements, in particular IS16, have facilitated niche adaptation of this distinct E. faecium subpopulation that is multiply resistant to antibiotics. Quinupristin/dalfopristin and linezolid are licensed for the treatment of VREm infections, with linezolid often used as a first-line treatment. However, the emergence of plasmid-mediated resistance to linezolid by production of a Cfr methyltransferase in Enterococcus faecalis is worrying. Daptomycin has not been extensively evaluated for the treatment of VREm infections and resistant mutants have been selected under daptomycin therapy. Although control of VRE is challenging, a laissez-faire policy would result in an increased number of infections and would create an irreversible situation. Although so far unsuccessful, dissemination of glycopeptide-resistant Staphylococcus aureus with van genes acquired from resistant enterococci cannot be ruled out.

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Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus.

Johanna Watson, Catey Bunce, O. E. Craig … (2004)

To compare the therapeutic outcomes after deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) in patients with keratoconus. Retrospective case-control study. We reviewed the clinical notes of 47 patients diagnosed clinically with keratoconus who had received DLK (26 eyes of 25 patients) or PK (25 eyes of 22 patients) at Moorfields Eye Hospital or the Royal Shrewsbury Hospital between 1994 and 2001. The patients in the 2 groups were matched for severity of their keratoconus by preoperative visual acuity. Deep lamellar keratoplasty was performed with the Melles technique in 7 eyes and the technique described by Sugita and Kondo in 19 eyes. Penetrating keratoplasty was performed with a standard technique using a Hessburg-Barron trephine. A single continuous 16-bite 10-0 nylon suture was placed and adjusted in both groups. Best-corrected visual acuity (BCVA), refractive results, surgical techniques for DLK, and complication rates were analyzed. The 25 patients with keratoconus who underwent DLK had a mean age of 32.6 years and a median follow-up of 28 months. The mean age of the 22 patients who underwent PK for keratoconus was 34 years. This group was followed up for a median time of 55 months. The median final BCVA of patients in the DLK group was 6/9 and in the PK group 6/6 (no statistical significance). The median result for the final spherical equivalent power in both groups was mild myopia, although the DLK group had more myopia, and the median astigmatism was less than 5.00 diopters cylinder for both groups. Complication rates were similar for DLK and PK, although the nature of the complications varied. Penetrating keratoplasty is no longer an automatic choice for the surgical treatment for keratoconus; DLK seems to be a safe alternative. Best-corrected visual acuity, refractive results, and complication rates are similar after DLK and PK. Deep lamellar keratoplasty is more technically challenging but allows the risk of endothelial rejection to be avoided and may reduce the risk of late endothelial failure.

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Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review.

Ronald C. Gentile, Salil Shukla, Mahendra Shah … (2014)

To identify the spectrum and susceptibility pattern of pathogens responsible for culture-positive endophthalmitis referred to a single institution and investigate possible trends in both pathogens and antibiotic sensitivities over the past 25 years.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: September 2019

Publication date (Electronic): 13 September 2019

Volume: 98

Issue: 37

Electronic Location Identifier: e17140

Affiliations

Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy.

Author notes

[∗ ]Correspondence: Francesco D’Oria, Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, piazza Giulio Cesare 11, Bari 70124, Italy (e-mail: francescodoria91@ 123456hotmail.it ).

Article

Publisher ID: MD-D-19-01524 Accession ID: 17140

DOI: 10.1097/MD.0000000000017140

PMC ID: 6750735

PubMed ID: 31517855

SO-VID: 6432faa8-f1fd-424f-982a-f4b116f304f1

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 23 February 2019

Date revision received : 15 July 2019

Date accepted : 20 August 2019

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Keywords: deep anterior lamellar keratoplasty,enterococcus faecium,interface infection,penetrating keratoplasty

Data availability:

Keywords: deep anterior lamellar keratoplasty, enterococcus faecium, interface infection, penetrating keratoplasty

Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty : A case report and review of the literature

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Abstract

Rationale:

Patient concerns:

Diagnoses:

Interventions:

Outcomes:

Lessons:

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Network Medicine

Most cited references 21

Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce?

Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus.

Microbiological spectrum and antibiotic sensitivity in endophthalmitis: a 25-year review.

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