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Ong HS, Sharma N, Phee LM, Mehta JS. Atypical microbial keratitis. Ocul Surf 2023; 28:424-439. [PMID: 34768003 DOI: 10.1016/j.jtos.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/16/2023]
Abstract
Atypical microbial keratitis refers to corneal infections caused by micro-organisms not commonly encountered in clinical practice. Unlike infections caused by common bacteria, cases of atypical microbial keratitis are often associated with worse clinical outcomes and visual prognosis. This is due to the challenges in the identification of causative organisms with standard diagnostic techniques, resulting in delays in the initiation of appropriate therapies. Furthermore, due to the comparatively lower incidence of atypical microbial keratitis, there is limited literature on effective management strategies for some of these difficult to manage corneal infections. This review highlights the current management and available evidence of atypical microbial keratitis, focusing on atypical mycobacteria keratitis, nocardia keratitis, achromobacter keratitis, and pythium keratitis. It will also describe the management of two uncommonly encountered conditions, infectious crystalline keratopathy and post-refractive infectious keratitis. This review can be used as a guide for clinicians managing patients with such challenging corneal infections.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore.
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Lynette M Phee
- Department of Pathology, Sengkang General Hospital, SingHealth, Singapore
| | - Jodhbir S Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
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Abstract
PURPOSE To help clinicians diagnose and manage unilateral recalcitrant chronic bacterial conjunctivitis secondary to a retained soft contact lens and describe the first report of Gram-negative bacteria causing this condition. METHODS Chart review of successive cases presenting with unilateral chronic conjunctivitis with positive cultures and a retained contact lens. RESULTS Three cases were identified and described. Culturing of the retained contact lenses grew Pseudomonas aeruginosa in the first case, Achromobacter xylosoxidans in the second, and Staphylococcus epidermidis in the third. All three patients were successfully treated with removal of the retained lens and targeted antibiotic eyedrop therapy. CONCLUSIONS Unilateral chronic recurrent or recalcitrant purulent papillary conjunctivitis is rare, and a retained contact lens should be suspected in patients with a history of wearing contact lenses. Careful examination with double eversion of the upper eyelid and sweeping of the fornices can recover the offending lens. Although only Gram-positive organisms have been isolated in previous reports, two of our three cultures grew Gram-negative organisms, highlighting the importance of broad-spectrum antibiotic usage for these cases.
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Dantam J, Subbaraman LN, Jones L. Adhesion of Pseudomonas aeruginosa, Achromobacter xylosoxidans, Delftia acidovorans, Stenotrophomonas maltophilia to contact lenses under the influence of an artificial tear solution. BIOFOULING 2020; 36:32-43. [PMID: 31973583 DOI: 10.1080/08927014.2019.1710832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
Corneal infection is a devastating sight-threatening complication that is associated with contact lens (CL) wear, commonly caused by Pseudomonas aeruginosa. Lately, Achromobacter xylosoxidans, Delftia acidovorans, and Stenotrophomonas maltophilia have been associated with corneal infection. This study investigated the adhesion of these emerging pathogens to CLs, under the influence of an artificial tear solution (ATS) containing a variety of components commonly found in human tears. Two different CL materials, etafilcon A and senofilcon A, either soaked in an ATS or phosphate buffered saline, were exposed to the bacteria. Bacterial adhesion was investigated using a radio-labeling technique (total counts) and plate count method (viable counts). The findings from this study revealed that in addition to P. aeruginosa, among the emerging pathogens evaluated, A. xylosoxidans showed an increased propensity for adherence to both CL materials and S. maltophilia showed lower viability. ATS influenced the viable counts more than the total counts on CLs.
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Affiliation(s)
- Jaya Dantam
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Lakshman N Subbaraman
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
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Ung L, Bispo PJM, Shanbhag SS, Gilmore MS, Chodosh J. The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 2019; 64:255-271. [PMID: 30590103 PMCID: PMC7021355 DOI: 10.1016/j.survophthal.2018.12.003] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 01/16/2023]
Abstract
Microbial keratitis is a potentially blinding condition that must be treated emergently to preserve vision. Although long recognized as a significant cause of corneal blindness, our understanding of its true global scale, associated burden of disease, and etiological patterns remains somewhat limited. Current epidemiological data suggest that microbial keratitis may be epidemic in parts of the world-particularly within South, South-East, and East Asia-and may exceed 2 million cases per year worldwide. Etiological patterns vary between economically developed and developing countries, with bacterial predominance in the former and fungal predominance in the latter. The key to effective management lies in timely diagnosis; however, the current gold standard of stain and culture remains time consuming and often yields no clinically useful results. For this reason, there are attempts to develop highly sensitive and accurate molecular diagnostic tools to provide rapid diagnosis, inform treatment decision making, and minimize the threat of antimicrobial resistance. We provide an overview of these key areas and of avenues for further research toward the goal of more effectively addressing the problem of microbial keratitis on both an individual and public health level.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J M Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India
| | - Michael S Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Istiaq A, Shuvo MSR, Rahman KMJ, Siddique MA, Hossain MA, Sultana M. Adaptation of metal and antibiotic resistant traits in novel β-Proteobacterium Achromobacter xylosoxidans BHW-15. PeerJ 2019; 7:e6537. [PMID: 30886770 PMCID: PMC6421061 DOI: 10.7717/peerj.6537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/29/2019] [Indexed: 12/22/2022] Open
Abstract
Chromosomal co-existence of metal and antibiotic resistance genes in bacteria offers a new perspective to the bacterial resistance proliferation in contaminated environment. In this study, an arsenotrophic bacterium Achromobacter xylosoxidans BHW-15, isolated from Arsenic (As) contaminated tubewell water in the Bogra district of Bangladesh, was analyzed using high throughput Ion Torrent Personal Genome Machine (PGM) complete genome sequencing scheme to reveal its adaptive potentiality. The assembled draft genome of A. xylosoxidans BHW-15 was 6.3 Mbp containing 5,782 functional genes, 1,845 pseudo genes, and three incomplete phage signature regions. Comparative genome study suggested the bacterium to be a novel strain of A. xylosoxidans showing significant dissimilarity with other relevant strains in metal resistance gene islands. A total of 35 metal resistance genes along with arsenite-oxidizing aioSXBA, arsenate reducing arsRCDAB, and mercury resistance merRTPADE operonic gene cluster and 20 broad range antibiotic resistance genes including β-lactams, aminoglycosides, and multiple multidrug resistance (MDR) efflux gene complex with a tripartite system OM-IM-MFP were found co-existed within the genome. Genomic synteny analysis with reported arsenotrophic bacteria revealed the characteristic genetic organization of ars and mer operonic genes, rarely described in β-Proteobacteria. A transposon Tn21 and mobile element protein genes were also detected to the end of mer (mercury) operonic genes, possibly a carrier for the gene transposition. In vitro antibiotic susceptibility assay showed a broad range of resistance against antibiotics belonging to β-lactams, aminoglycosides, cephalosporins (1st, 2nd, and 3rd generations), monobactams and even macrolides, some of the resistome determinants were predicted during in silico analysis. KEGG functional orthology analysis revealed the potential of the bacterium to utilize multiple carbon sources including one carbon pool by folate, innate defense mechanism against multiple stress conditions, motility, a proper developed cell signaling and processing unit and secondary metabolism-combination of all exhibiting a robust feature of the cell in multiple stressed conditions. The complete genome of the strain BHW-15 stands as a genetic basis for the evolutionary adaptation of metal and the antibiotic coexistence phenomenon in an aquatic environment.
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Affiliation(s)
- Arif Istiaq
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.,Department of Microbiology, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Sadikur Rahman Shuvo
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.,Department of Microbiology, Noakhali Science and Technology University, Noakhali, Bangladesh
| | | | | | - M Anwar Hossain
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
| | - Munawar Sultana
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
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Abstract
OBJECTIVES Ocular infections due to Achromobacter xylosoxidans are extremely uncommon; their diagnosis is a challenge and the optimal treatment remains controversial. We present a case of A. xylosoxidans in a contact lens user and a review of the literature to facilitate diagnostic suspicion and empirical therapeutic management. METHODS Review of the literature in PubMed and MEDLINE. We also document a case diagnosed in our department in January 2016. SETTING Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. RESULTS According to the literature, clinical manifestations and antibiotic sensitivity of A. xylosoxidans varied greatly. Our patient with no history of keratopathy presented three risk factors that made the diagnosis suspicious. The infection was resolved with topical moxifloxacin and fluorometholone. CONCLUSIONS A. xylosoxidans is an uncommon cause of infection, but must be suspected in atypical keratitis, reported contact with warm or still waters, use of contact lenses, or previous corneal damage. In these cases, microbiological studies and antibiotic sensitivity testing are particularly important.
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Adhesion of Stenotrophomonas maltophilia, Delftia acidovorans, and Achromobacter xylosoxidans to Contact Lenses. Eye Contact Lens 2018; 44 Suppl 2:S120-S126. [DOI: 10.1097/icl.0000000000000425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spierer O, Miller D, O'Brien TP. Comparative activity of antimicrobials against Pseudomonas aeruginosa, Achromobacter xylosoxidans and Stenotrophomonas maltophilia keratitis isolates. Br J Ophthalmol 2018; 102:708-712. [PMID: 29459431 DOI: 10.1136/bjophthalmol-2017-311751] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/27/2018] [Accepted: 02/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Achromobacter xylosoxidans and Stenotrophomonas maltophilia are emerging corneal pathogens, which are closely related to Pseudomonas aeruginosa, and have intrinsic resistance to many commonly available antimicrobials. The purpose of this study is to compare the in vitro efficacy of 12 antimicrobial agents against A. xylosoxidans, S. maltophilia and P. aeruginosa isolates recovered from clinical cases of keratitis. METHODS Recovered corneal isolates (n=58) were identified and extracted from the Microbiology Data Bank of the Bascom Palmer Eye Institute. Comparative in vitro minimum inhibitory concentration (MIC) susceptibility profiles for fluoroquinolones, aminoglycosides, beta-lactams and miscellaneous antibiotics were recorded using the E-test methodology. Pharmacodynamic indices (Cmax/MIC) were calculated. RESULTS A. xylosoxidans and S. maltophilia isolates were resistant to fluoroquinolones, aminoglycosides and ceftazidime (susceptibility rate ranging from 0% to 30%) while P. aeruginosa isolates showed a susceptibility rate of 95%-100% to these antimicrobials (P<0.00001 for the various antimicrobials). Exception was moxifloxacin with 80% of susceptibility rate to S. maltophilia isolates and Cmax/MIC=10.19. Ninety to 100% susceptibility rates were found for minocycline and trimethoprim/sulfamethoxazole for both A. xylosoxidans and S. maltophilia. One hundred per cent of the A. xylosoxidans isolates were susceptible to piperacillin/tazobactam and ticarcillin/clavulanic acid. CONCLUSIONS There is a significant difference in susceptibility patterns between A. xylosoxidans, S. maltophilia and P. aeruginosa. Fluoroquinolones and aminoglycosides may not be effective against A. xylosoxidans and S. maltophilia. Antibiotics that are not commercially available as eye drops, such as beta-lactams for A. xylosoxidans, and trimethoprim/sulfamethoxazole and minocycline for both A. xylosoxidans and S. maltophilia should be considered.
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Affiliation(s)
- Oriel Spierer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.,Ophthalmology Department, Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Darlene Miller
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Terrence P O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Clinical Features, Antibiotic Susceptibility Profiles, and Outcomes of Infectious Keratitis Caused by Achromobacter xylosoxidans. Cornea 2016; 35:626-30. [PMID: 26989957 DOI: 10.1097/ico.0000000000000798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Reports on Achromobacter xylosoxidans ocular infections are increasing, drawing attention to its emerging role in infectious keratitis. The purpose of this study is to report the clinical features, antibiotic sensitivities, and visual outcomes of infectious keratitis secondary to Achromobacter xylosoxidans. METHODS A microbiology database and clinical chart review was performed in all patients diagnosed with A. xylosoxidans keratitis at the Bascom Palmer Eye Institute between the years 1987 and 2014. Initial presentation, antimicrobial susceptibilities, minimum inhibitory concentrations (MICs), treatment course, and outcomes were recorded. RESULTS Twenty-eight patients were identified. The main risk factors were corneal graft (n = 8, 28.6%) and contact lens wear (n = 8, 28.6%). On presentation, visual acuity was 20/100 or worse in 20 (71.2%) patients. Hypopyon was present in 7 (25.0%) patients. In most cases, topical fluoroquinolones or tobramycin were the initial treatment, often accompanied by vancomycin. High susceptibility rates were found for piperacillin [100%, minimum inhibitory concentration for 90% of isolates (MIC90) = 8] and ticarcillin (100%, MIC90 = 16). Low susceptibility rates were documented for ciprofloxacin (46.7%, MIC90 = 8), tobramycin (26.7%, MIC90 = 16), and gentamicin (20%, MIC90 = 16). One (3.6%) patient suffered endophthalmitis. Six (21.4%) patients underwent therapeutic penetrating keratoplasty, and 2 (7.1%) patients had conjunctival flap surgery. Visual acuity at final follow-up was 20/100 or worse in 16 (57.1%) patients. CONCLUSIONS Infectious keratitis caused by A. xylosoxidans is associated with poor visual outcomes. Fluoroquinolones and aminoglycosides are not appropriate treatments for these ocular infections. Further studies are needed to define the clinical application of compound piperacillin and ticarcillin eye drops.
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Hotta F, Eguchi H, Naito T, Mitamura Y, Kusujima K, Kuwahara T. Achromobacter buckle infection diagnosed by a 16S rDNA clone library analysis: a case report. BMC Ophthalmol 2014; 14:142. [PMID: 25421607 PMCID: PMC4255664 DOI: 10.1186/1471-2415-14-142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/18/2014] [Indexed: 11/15/2022] Open
Abstract
Background In clinical settings, bacterial infections are usually diagnosed by isolation
of colonies after laboratory cultivation followed by species identification with
biochemical tests. However, biochemical tests result in misidentification due to
similar phenotypes of closely related species. In such cases, 16S rDNA sequence
analysis is useful. Herein, we report the first case of an Achromobacter-associated buckle infection that was diagnosed by 16S
rDNA sequence analysis. This report highlights the significance of Achromobacter spp. in device-related ophthalmic
infections. Case presentation A 56-year-old woman, who had received buckling surgery using a silicone solid
tire for retinal detachment eighteen years prior to this study, presented purulent
eye discharge and conjunctival hyperemia in her right eye. Buckle infection was
suspected and the buckle material was removed. Isolates from cultures of
preoperative discharge and from deposits on the operatively removed buckle
material were initially identified as Alcaligenes and Corynebacterium
species. However, sequence analysis of a 16S rDNA clone library using the DNA
extracted from the deposits on the buckle material demonstrated that all of the
16S rDNA sequences most closely matched those of Achromobacter spp. We concluded that the initial misdiagnosis of
this case as an Alcaligenes buckle infection
was due to the unreliability of the biochemical test in discriminating Achromobacter and Alcaligenes species due to their close taxonomic positions and
similar phenotypes. Corynebacterium species
were found to be contaminants from the ocular surface. Conclusions Achromobacter spp. should be recognized as
causative agents for device-related ophthalmic infections. Molecular species
identification by 16S rDNA sequence analysis should be combined with conventional
cultivation techniques to investigate the significance of Achromobacter spp. in ophthalmic infections.
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Affiliation(s)
| | - Hiroshi Eguchi
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan.
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Park JH, Song NH, Koh JW. Achromobacter xylosoxidans keratitis after contact lens usage. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:49-53. [PMID: 22323886 PMCID: PMC3268169 DOI: 10.3341/kjo.2012.26.1.49] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/19/2011] [Indexed: 11/23/2022] Open
Abstract
To report on Achromobacter xylosoxidans keratitis in two healthy patients who had worn contact lenses foran extended period of time. A 36-year-old female and a 21-year-old female visited our hospital with ocular pain and blurred vision. Both patients had a history of wearing soft contact lenses for over fve years with occasional overnight wear. At the initial presentation, a slit lamp examination revealed corneal stromal infiltrations and epithelial defects with peripheral neovascularization in both patients. Microbiological examinations were performed from samples of corneal scrapings, contact lenses, contact lens cases, and solution. The culture resulting from the samples taken from the contact lenses, contact lens cases, and solution were all positive for Achromobacter xylosoxidans. Confrming that the direct cause of the keratitis was the contact lenses, the frst patient was prescribed ceftazidime and amikacin drops sensitive to Achromobacter xylosoxidans. The second patient was treated with 0.3% gatifoxacin and fortifed tobramycin drops. After treatment, the corneal epithelial defects were completely healed, and subepithelial corneal opacity was observed. Two cases of Achromobacter xylosoxidans keratitis were reported in healthy young females who wore soft contact lenses. Achromobacter xylosoxidans should be considered a rare but potentially harmful pathogen for lens-induced keratitis in healthy hosts.
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Affiliation(s)
- Jung Hyun Park
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
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Alcaligenes xylosoxidans Contact Lens–Related Keratitis—A Case Report and Literature Review. Eye Contact Lens 2011; 37:386-9. [DOI: 10.1097/icl.0b013e318235893a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim CR, Kim GN, Kim KH, Yoo JM, Seo SW. A Case of Chronic Dacryocystitis Caused by Achromobacter Xylosoxidans. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.8.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Che Ron Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyu Nam Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyeong Hyeon Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Myong Yoo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seong Wook Seo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Kim YR, You IC, Lee HS. A Case of Achromobacter XylosoxidansKeratitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.11.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- You Ra Kim
- Department of Ophthalmology, Chonbuk National University School of Medicine, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Hye Soo Lee
- Department of Laboratory Medicine, Chonbuk National University School of Medicine, Jeonju, Korea
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Clinical, microbiological profile and treatment outcome of ocular infections caused by Achromobacter xylosoxidans. Cornea 2010; 28:1100-3. [PMID: 19730091 DOI: 10.1097/ico.0b013e3181a1658f] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To study the microbiological profile and outcome of ocular infections caused by Achromobacter xylosoxidans. METHODS Medical and microbiology records of patients with A. xylosoxidans ocular infections managed between May 2007 and December 2007 were reviewed. RESULTS The authors identified 10 patients whose eyes were infected by A. xylosoxidans during the study period. Of 10 patients, 8 had microbial keratitis, of whom 6 developed an infection after penetrating keratoplasty. The remaining 2 patients had endophthalmitis. The Gram-stained smear did not reveal any organism in 6 of 10 cases. In the 4 remaining cases, Gram-negative bacilli were reported. Out of 10 isolates, 9 were sensitive to ceftazidime, 7 to amikacin, 5 to ciprofloxacin, and 3 to ofloxacin, gatifloxacin, and chloramphenicol. Only one isolate was sensitive to moxifloxacin. Of the 6 patients with graft infection, 2 patients were lost to follow-up, infection was resolved in 3 patients, and the infection remained active in 1 patient. The two patients with endophthalmitis responded to antibacterial therapy and showed improved visual acuity. Infection was resolved in 2 patients with keratitis. CONCLUSION Although A. xylosoxidans ocular infections are rare, one should retain a high index of clinical suspicion in patients who present with slowly progressive disease characterized by a localized infiltration and show Gram-negative bacilli on smear examination.
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Cho YK, Gi DH, Kim HK, La TY. A Case of Alcaligenes xylosoxidans Keratitis in a Soft Contact Lens Wearer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.11.1525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yang Kyung Cho
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Dong Hyun Gi
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Hyun Kyung Kim
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
| | - Tae Yoon La
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, The Catholic University of Korea School of Medicine, Suwon, Korea
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Multiple Drug-Resistant Alcaligenes xylosoxidans Keratitis in a Sanitation Worker. Eye Contact Lens 2009; 35:212-4. [DOI: 10.1097/icl.0b013e3181aac4fd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Srinivasan S, McAllum P, Poutanen SM, Slomovic AR. Bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty. J Cataract Refract Surg 2007; 32:2149-52. [PMID: 17138001 DOI: 10.1016/j.jcrs.2006.06.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
We report a case of severe bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty (PKP) in a patient with graft-versus-host disease. The predisposing factors, clinical features, treatment options, and final visual outcome are reviewed. To our knowledge, this is the first report of bilateral A xylosoxidans keratitis following PKP.
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Oh JY, Shin YJ, Wee WR. A case of epidemic keratoconjunctivitis complicated by Alcaligenes xylosoxidans infection. KOREAN JOURNAL OF OPHTHALMOLOGY 2005; 19:233-4. [PMID: 16209287 DOI: 10.3341/kjo.2005.19.3.233] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a case of epidemic keratoconjunctivitis complicated by Alcaligenes xylosoxidans. METHODS A 37-year-old man suffered epidemic keratoconjunctivitis in both eyes. Eleven days later, he developed a corneal ulcer in his left eye. Bacterial staining, culture, and antibiotics sensitivity test were performed from a corneal scrape. RESULTS The cultures revealed a growth of Alcaligenes xylosoxidans, and the patient was treated with ceftazidime and levofloxacin, based on the sensitivity test results. After 21 days of treatment, the infection was resolved with mild scaring and final vision in the left eye of 20/20. CONCLUSIONS Alcaligenes xylosoxidans should be considered a rare but potential pathogen able to produce comeal ulcer complication in epidemic keratoconjunctivitis.
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Affiliation(s)
- Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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21
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Abstract
PURPOSE To describe a case of postkeratoplasty recurrent Alcaligenes xylosoxidans keratitis. METHODS A 33-year-old man with a history of penetrating keratoplasty developed corneal infiltrate with intact epithelium and then was treated with broad-spectrum antibiotics. Corneal scraping was taken for microbiologic study. RESULTS The culture result identified A. xylosoxidans, sensitive to piperacillin and ceftazidime. There were 3 recurrent episodes within 2 months after each apparent resolution achieved after the instillation of topical piperacillin (10 mg/mL). During the fourth attack, the lesion responded poorly to piperacillin and ceftazidime (25 mg/mL), so therapeutic penetrating keratoplasty was performed to eradicate the recalcitrant infection. CONCLUSIONS A. xylosoxidans has probably been underreported as a cause of ocular infection. It does not respond to conventional antibiotic therapy and may be difficult to eradicate. Therapeutic penetrating keratoplasty might be necessary if medical treatment fails.
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Affiliation(s)
- Zei-Lun Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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22
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Pan TH, Heidemann DG, Dunn SP, Chow CY, Gossage D. Delayed onset and recurrent Alcaligenes xylosoxidans keratitis. Cornea 2000; 19:243-5. [PMID: 10746461 DOI: 10.1097/00003226-200003000-00022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- T H Pan
- Pontiac Osteopathic Hospital, Michigan, USA
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23
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Van Horn KG, Gedris CA, Ahmed T, Wormser GP. Bacteremia and urinary tract infection associated with CDC group Vd biovar 2. J Clin Microbiol 1989; 27:201-2. [PMID: 2913028 PMCID: PMC267265 DOI: 10.1128/jcm.27.1.201-202.1989] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A case of urinary tract infection and bacteremia caused by CDC group Vd biovar 2 in a 23-year-old woman with Hodgkin's disease is described. This is the first report of CDC group Vd biovar 2 isolated from a clinical specimen and considered as a pathogen. Detailed antimicrobial susceptibility data are presented.
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Affiliation(s)
- K G Van Horn
- Department of Clinical Pathology, Westchester County Medical Center, Valhalla, New York
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24
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Glupczynski Y, Hansen W, Freney J, Yourassowsky E. In vitro susceptibility of Alcaligenes denitrificans subsp. xylosoxidans to 24 antimicrobial agents. Antimicrob Agents Chemother 1988; 32:276-8. [PMID: 3163242 PMCID: PMC172153 DOI: 10.1128/aac.32.2.276] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The in vitro susceptibilities of 37 clinical isolates of Alcaligenes denitrificans subsp. xylosoxidans to 24 antimicrobial agents were determined. Imipenem was the only drug with consistent activity (MIC for 90% of isolates, 2 micrograms/ml). Piperacillin, ticarcillin-clavulanic acid, ceftazidime, and co-trimoxazole were active against most strains. All the isolates were resistant to ampicillin, cefazolin, cefuroxime, cefamandole, cefotetan, ceftriaxone, cefotaxime, aztreonam, amdinocillin, and temocillin. Most isolates were resistant to the aminoglycosides tested, including amikacin. Lack of activity was also observed for all new 4-quinolone antimicrobial agents.
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Affiliation(s)
- Y Glupczynski
- Department of Clinical Microbiology, Brugmann University Hospital, Brussels, Belgium
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25
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Abstract
A xylosoxidans is being recognized as an important nosocomial pathogen. As more patients are rendered immunosuppressed by chemotherapy, this organism's increasing role in hospital-acquired infections will be assured. Achromobacter is a water-borne organism, highly resistant to most antibiotics, and even to some disinfectant solutions, and easily establishes itself in the hospital aquatic environment. Achromobacter infections and outbreaks should be recognized and approached as serious problems requiring the institution of appropriate infection control measures. A xylosoxidans infections should be empirically treated with a combination of a third generation cephalosporin and TMP-SMX pending susceptibility testing.
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Affiliation(s)
- P E Schoch
- Department of Pathology, Winthrop-University Hospital, Mineola, New York 11501
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26
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Schoch PE, Cunha BA. Nosocomial Achromobacter xylosoxidans Infections. Infect Control Hosp Epidemiol 1988. [DOI: 10.2307/30144148] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Arroyo JC, Jordan W, Lema MW, Brown A. Diversity of plasmids in Achromobacter xylosoxidans isolates responsible for a seemingly common-source nosocomial outbreak. J Clin Microbiol 1987; 25:1952-5. [PMID: 3667915 PMCID: PMC269374 DOI: 10.1128/jcm.25.10.1952-1955.1987] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Achromobacter xylosoxidans, an uncommon yet highly resistant opportunistic pathogen, was isolated from nine hospitalized patients during an 8-month period. It had been isolated from only seven patients with either nonfatal infection or colonization from 1981 to 1984. From June 1985 to January 1986, A. xylosoxidans was isolated 18 times from seven different sites (sputum, 7 times; urine, 4 times; blood, 3 times; and lung, pleural fluid, wound tissue, and tracheal aspirate, 1 time each). Four patients died, including the three with bacteremia. All but two patients had nosocomial infections and either were on the same ward or were cared for by the same staff members. Eleven A. xylosoxidans strains yielded eight distinct plasmids (8, 21, 23, 26, 38, 50, 51, and 64 megadaltons). Whole-cell peptide patterns of 10 of these strains were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Isolates from the same patient contained the same plasmids and had identical peptide patterns but differed from other strains in both parameters. Plasmids were absent from the two community-acquired isolates. Although nosocomial strains showed similar antibiotic resistance patterns (only moxalactam and ticarcillin-clavulanic acid were uniformly active) and cross-contamination was strongly suggested epidemiologically, results of plasmid and peptide analyses did not support the possibility of a single-strain outbreak.
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Affiliation(s)
- J C Arroyo
- Medical and Research Services, Dorn Veterans Administration Hospital, Columbia, South Carolina
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28
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Chandrasekar PH, Arathoon E, Levine DP. Infections due to Achromobacter xylosoxidans. Case report and review of the literature. Infection 1986; 14:279-82. [PMID: 3818105 DOI: 10.1007/bf01643962] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Achromobacter xylosoxidans is an uncommon nosocomial pathogen known to cause many serious infections. A 69-year-old woman with diabetes mellitus and chronic renal failure was admitted with pulmonary edema. The patient developed fever and pulmonary infiltrate with bilateral pleural effusions while she was on a respirator in the intensive care unit. Culture of sputum, pleural fluid and blood grew A. xylosoxidans. Bilateral chest tubes were inserted and the patient was treated for one month with piperacillin and trimethoprim-sulfamethoxazole. Gradual response, both clinically and radiologically, was noted after prolonged therapy. A review of the literature on infections due to A. xylosoxidans, the unique susceptibility pattern of the organism to various antibiotics and the use of combination therapy in Achromobacter infections are discussed.
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