This is a retrospective review of all patients’ records from a tertiary referral centre in India from January 2018 to December 2019, who had corneal scrapings for direct smear and culture sensitivity. Those cases where the organisms were diagnosed to be resistant to three or more classes of antibiotics were included in the study. Forty patients were included and the mean age was 50.9 years. The most common risk factors were vegetative trauma (12 eyes, 30%), corneal transplantation (seven eyes, 17.7%) and systemic morbidities (seven eyes, 17.5%). Small infiltrates (< 6mm) were in 22 eyes and 18 were large infiltrates (> 6mm). Superficial, mid and deep stromal involvement was in 11, nine and 15 eyes respectively. Eighteen eyes had gram-negative bacilli and pseudomonas aeruginosa (15%) was most common. Resistance to three or four classes was in 17 eyes each and one case was resistant to all seven classes of drugs. Fifteen eyes had complete resolution on medical treatment only and five eyes required therapeutic penetrating keratoplasty. Size of the filtrate was a significant factor correlating the outcome (p=0.002). The authors concluded that inappropriate usage of topical and systemic antibiotics should be discouraged.
Multidrug-resistant keratitis: challenging yet manageable
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