Treatment of multidrug-resistant Flavobacterium indologenes keratitis with trimethoprim-sulfamethoxazole

Purpose: To describe the history, clinical presentation, and successful medical management of a case of multidrug-resistant Flavobacterium indologenes keratitis. Methods: An 83-year-old pseudophakic female presented with a 2-day history of decreased visual acuity, light sensitivity and dull ocular pain in her right eye. Two weeks More presentation, the patient had been treated for a red eye with combination topical loteprednol etabonate (0.5%) and tobramycin (0.3%) eye drops. Corneal scrappings were performed by the referring ophthalmologist,, and hourly administration of gatifloxacin 0.3% eye drops was started. Evaluation consisted of slit lamp examination, organism identification, and antibiotic sensitivity testing. Results: Examination of the right eye revealed a central 5-mm X 2-mm anterior stromal infiltrate with an overlying epithelial defect. Gatifloxacin 0.3% eye drops were stopped, and hourly topical fortified vancomycin (50 mg/mL) and ceftazidime (50 mg/mL) eye drops Were instituted. Oxidase-positive gram-negative bacilli were idenitified in the thioglycollate broth on day 3, and therefore, vancomycin was discontinued and hourly ciprofloxacin 0.3% eye drops were added to the regimen. The cultures ultimately grew F. indologenes, which was highly resistant to all antibiotics tested except for trimethoprim-sulfamethoxazole. Accordingly. ciprofloxacin 0.3% and ceftazidime were discounted. The patient,was started oil hourly topical trimethoprim (16 mg/mL)/sulfamethoxazole (80 mg/mL) eye drops, resulting in clinical control of the infection over a period of 1 month. Conclusions: Flavobacterium hidologenes keratitis can be resistant to treatment with in any medications, and antibiotic susceptibility profile testing in these cases may provide crucial information to help eradicate the infection.