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Wang T, Jain S, Glidai Y, Dua P, Dempsey KS, Shakin E, Chu DS, Epstein M, Ha LG. Extensively drug-resistant Pseudomonas aeruginosa panophthalmitis from contaminated artificial tears. IDCases 2023; 33:e01839. [PMID: 37645532 PMCID: PMC10461124 DOI: 10.1016/j.idcr.2023.e01839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 08/31/2023] Open
Abstract
Pseudomonas aeruginosa is one of the common gram-negative organisms that cause severe invasive infections in different organ systems. P. aeruginosa has unique intrinsic mechanisms to develop antimicrobial resistance quickly, making it extremely difficult to treat. We report a case of extensively drug-resistant (XDR) P. aeruginosa panophthalmitis due to contaminated artificial tears. This report investigates the role of systemic and intravitreal antimicrobials, summarizes the resistance mechanisms of P. aeruginosa, and provides an overview on cefiderocol, a novel antimicrobial that targets multidrug-resistant (MDR) and XDR Gram-negative pathogens.
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Affiliation(s)
- Taylor Wang
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
| | - Sumeet Jain
- Department of Pharmacy, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030, USA
| | - Yoav Glidai
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Prachi Dua
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Katharine S. Dempsey
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - Eric Shakin
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030, USA
| | - David S. Chu
- Institute of Ophthalmology and Visual Science, New Jersey Medical School of Rutgers University, 90 Bergen St., Newark, NJ 07103, USA
- Metropolitan Eye Research and Surgery Institute, 540 Bergen Blvd., Palisades Park, NJ 07650, USA
| | - Marcia Epstein
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
| | - Lawrence G. Ha
- Dayton and Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 400 Community Dr, Manhasset, NY 11030, USA
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Lago K, Decker CF, Chung KK, Blyth D. Difficult to Treat Infections in the Burn Patient. Surg Infect (Larchmt) 2020; 22:95-102. [PMID: 32466741 DOI: 10.1089/sur.2020.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Unusual infections can lead to complications in more severely burned patients and pose major challenges in treatment. Methods: The published literature of retrospective reviews and case series of the uncommon infections of osteomyelitis, polymicrobial bacteremia, recurrent bacteremia, endocarditis, central nervous system (CNS), and rare fungal infections in burned patients have been summarized and presented. Results: When compared with infections occurring in the non-burn population, these infections in burn patients are more likely to be because of gram-negative bacteria or fungi. Because of hyperdynamic physiology and changes in immunomodulatory response secondary to burns, the clinical presentation of these infections in a patient with major burns differs from that of the non-burn patient and may not be identified until the post-mortem examination. Some of these infections (osteomyelitis, endocarditis, CNS, rare fungal infections) may necessitate surgical intervention in addition to antimicrobial therapy to achieve cure. The presence of the burn and allograft can also present unique challenges for surgical management. Conclusions: These difficult and unusual infections in the severely burned patient necessitate an index of suspicion, appropriate diagnosis, identification and sensitivities of the putative pathogen, effective systemic antimicrobial therapy, and appropriate surgical intervention if recovery is to be achieved.
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Affiliation(s)
- Kathryn Lago
- Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Catherine F Decker
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Dana Blyth
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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