두 종류의 항생제내성균에 의한 세균각막염과 안내염 동반 1예

Purpose: To report a case of infectious keratitis and endophthalmitis caused by two types of antibiotic-resistant bacteria.Case summary: A 62-year-old female patient presented to our clinic with left ocular pain for 2 weeks and was diagnosed with herpetic keratitis and anterior uveitis.At the initial presentation, slit lamp biomicroscopy revealed round stromal infiltration and edema in the paracentral part of the cornea, a 2 × 2-mm epithelial defect, and hypopyon.Ocular ultrasonography showed vitreous opacities.She was empirically treated with topical 0.5% moxifloxacin, 2% tobramycin, and 5% ceftazidime administered hourly.Intravitreal vancomycin/ceftazidime administration was performed on days 2 and 7 following treatment.Corneal culture revealed extended-spectrum β-lactamase-producing Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus on day 4 after treatment.Consequently, 2% tobramycin was replaced with 1% vancomycin.The corneal lesion gradually improved and healed completely with a residual corneal opacity at 4 weeks after treatment.Conclusions: Polymicrobial bacterial keratitis caused by antibiotic-resistant bacteria represents a treatment challenge.Therefore, culture is essential to obtain microbiological evidence and guide appropriate antibiotic selection.