ABSTRACT
PURPOSE/METHOD: To report a clinical case of a 21-year old male with a severe corneal abscess due to Pseudomonas aeruginosa refractory to intensive treatment with topical Ciprofloxacin. RESULTS/CONCLUSIONS: A corneal scrapping performed after a wash-out period showed Pseudomonas aeruginosa specimens, which were not sensitive to any of the fluoroquinolones tested. A fortified topical treatment with Ceftazidime healed the corneal abscess. Nowadays, the possibility of resistance to fluoroquinolones should be kept in mind, and we recommend treatment guided by the results of a microbiological study in severe and sight-threatening cases.
Subject(s)
Abscess/microbiology , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/pharmacology , Ceftazidime/therapeutic use , Ciprofloxacin/pharmacology , Corneal Ulcer/microbiology , Eye Infections, Bacterial/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Abscess/drug therapy , Adult , Anti-Bacterial Agents/pharmacology , Anti-Infective Agents/therapeutic use , Ceftazidime/pharmacology , Ciprofloxacin/therapeutic use , Contact Lenses, Hydrophilic , Corneal Ulcer/drug therapy , Drug Resistance, Microbial , Eye Infections, Bacterial/drug therapy , Humans , Male , Microbial Sensitivity Tests , Pseudomonas Infections/drug therapyABSTRACT
Objetivo/método: Presentar un caso clínico de un varón de 21 años con un absceso corneal severo causado por Pseudomonas aeruginosa refractario al tratamiento tópico intensivo con ciprofloxacino. Resultados/Conclusiones: Tras un período de lavado, se realizó un raspado corneal cuyo estudio microbiológico reveló la presencia de Pseudomonas aeruginosa resistente a todas las fluoroquinolonas testadas. El tratamiento tópico fortificado con Ceftazidima resolvió el absceso corneal. Consideramos que, en el momento actual, debe tenerse en cuenta la posibilidad de una resistencia a las quinolonas y recomendamos el tratamiento guiado por los resultados del estudio microbiológico en casos severos y con riesgo virtual (AU)
Subject(s)
Adult , Male , Humans , Eye Infections, Bacterial , Pseudomonas aeruginosa , Pseudomonas Infections , Anti-Infective Agents , Anti-Bacterial Agents , Ceftazidime , Ciprofloxacin , Contact Lenses, Hydrophilic , Drug Resistance, Microbial , Abscess , Microbial Sensitivity Tests , Corneal UlcerABSTRACT
BACKGROUND: For the empiric therapy of urinary tract infections (UTI) in the extra-hospital setting the susceptibility patterns of potential pathogens, among some other factors, should be considered. Thus, the evolution in susceptibility, mainly influenced by the previous consume of antibiotic, can be observed when comparing with susceptibility patterns in the previous years. MATERIAL AND METHODS: All isolates obtained from patients with bacteriuria from 4 Health Areas in Madrid for a 3-week period were collected. The susceptibility to 4 quinolones and other 9 antibiotics was determined by the agar dilution method. The chi square test was used to compare the results obtained with Escherrichia coli isolates with those obtained with the same method in 1992. RESULTS: A total of 945 isolates were recovered. E. coli accounted for 71.4% of isolates; other gram-negative bacilli for 20.2% and gram-positive cocci for 8.4%. The percentages of E. coli isolates susceptible to ampicillin, cotrimoxazole, norfloxacin and ciprofloxacin, phosphomycin, cefuroxime, and cefuroxime-axetil were 40.5, 74.7, 91.6, 97.8, 98.1 and 75.9, respectively. Isolates with cefotaxime MIC higher than 0.5 mg/l were not detected. Significant differences were observed (p < 0.01) for susceptibilities recorded in 1992 and 1995 for amoxycillin/clavulanic acid, cefazolin, and the four quinolones. The antibiotics with the best in vitro activity against the remaining gram-negative bacilli were norfloxacin and ciprofloxacin (98% of susceptible isolates), gentamicin (97%) and cefotaxime (95%). CONCLUSIONS: Changes in susceptibility results for E. coli between 1992 and 1995 have been observed. By 1995, there are commercially available antibiotics with good in vitro activity against pathogens with the potential of causing extra-hospital UTI in our setting.
