Bilateral multifocal pseudomonas aeruginosa keratitis in a contact lens-wearing diabetic patient treated with a custom compounded 5% imipenem-cilastatin topical solution


  • Arzu Taskiran Comez canakkale onsekiz mart university
  • Aydin Yildiz



keratitis, pseudomonas, pseudomonas aeruginosa, contact lens, imipenem, cilastatin, imipenem-cilastatin, fortified, topical, antibiotic, antibiotics, cornea, corneal, culture, diabetes, diabetic, ceftazidime, vancomycin, multidrug, resistant, resistance


Pseudomonas aeruginosa is a devastating agent of fulminant keratitis in contact lens-wearers, immunosuppressive patients, and refractive surgery patients which may lead to substantial loss of vision, and in severe cases, blindness.  In this case report, a 30-year-old diabetic contact lens wearer who had history of sleeping with lenses and prolonged use of the same contact lens presented with multiple foci of keratitis in each eye.  No pathogen was detected from corneal scrapings, but the contact lenses and the contact lens case were culture positive for Pseudomonas aeruginosa.  The keratitis was only partially responsive to topical fortified ceftazidime, topical fortified vancomycin, and topical fluconazole.  A decision was made to switch to topical imipenem-cilastatin due to the multiple risk factors, including diabetes, contact lens overuse, and bilateral multifocal corneal involvement, after which the keratitis resolved.  Topical imipenem-cilastatin may be a successful alternative treatment in patients with Pseudomonas keratitis who do not respond to conventional antibiotic therapy.

Author Biography

Arzu Taskiran Comez, canakkale onsekiz mart university

department of ophthalmology


Taher EE, Mahmoud NF, Negm S, et al. Severe, sight threatening microbial keratitis: coinfection of acanthamoeba and Pseudomonas in contact lens associated keratitis. Advances in Environmental Biology 2016; 10: 231–240.

Lakhundi S, Siddiqui R, Khan NA. Pathogenesis of microbial keratitis. Microbial Pathogenesis 2017; 104: 97-109.

Yeung KK, Forister JF, Forister EF, et al. Compliance with soft contact lens replacement schedules and associated contact lens-related ocular complications: the UCLA Contact Lens Study. Optometry 2010; 81(11): 598-607.

Pachigolla G, Blomquist P, Cavanagh HD. Microbial keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban country hospital in North Texas. Eye and Contact Lens. 2007; 33: 45–49.

Mah-Sadorra JH, Yavuz SG, Najjar DM, et al. Trends in contact lens-related corneal ulcers. Cornea. 2005; 24(1): 51–58.

Marquart M, O'Callaghan R. Infectious keratitis: secreted bacterial proteins that mediate corneal damage. Journal of Ophthalmology 2013; 36: 90-94.

Li YC, Zeldovich A, Chua BJ, et al. Hazardous contact: a case of visual loss following Pseudomonas keratitis from novelty contact lens wear. Medical Journal of Australia 2006; 185: 173-174.

Evans D, Fleiszig S. Why does the healthy cornea resist pseudomonas aeruginosa infection? American Journal of Ophthalmology 2013; 155: 961-970.

Sizmaz S, Bingollu S, Erdem E, et al. Polymicrobial infection of the cornea due to contact lens wear. Turkish Journal of Ophthalmology 2016; 46: 83-86.

Beattie TK, Tomlinson A. The effect of surface treatment of silicone hydrogel contact lenses on the attachment of acanthamoeba castellanii trophozoites. Eye and Contact Lens. 2009; 6: 316-319.

Musa F, Tailor R, Gao A. Contact lens-related microbial keratitis in deployed British military personel. British Journal of Ophthalmology 2010; 94: 988-993.

Makwana P, Abulafia A, Ondhia C, et al. Severe bilateral pseudomonas keratitis exacerbated by prolonged contact lens wear. Medical Journal of Australia 2014; 201(2): 112-113.

Carey IM, Critchley JA, DeWilde S, et al. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care 2018; 41(3): 513-521.

Sharma S. Antibiotic resistance in ocular bacterial pathogens. Indian Journal of Medical Microbiology 2011;29:218-22.

Mahin SP, Gerami P, Elmi A, et al. Pseudomonas aeruginosa keratitis: passive immunotherapy with antibodies raised against divalent flagellin. Iranian Journal of Basic Medical Sciences 2019; 22(1): 58–64.

Zhou C, Chen X, Wu L, et al. Distribution of drug-resistant bacteria and rational use of clinical antimicrobial agents. Experimental and Therapeutic Medicine 2016; 11(6): 2229-2232.

Ku JY, Kim P, Tong J, et al. Multiresistant pseudomonas keratitis. Clinical and Experimental Ophthalmology 2010; 38(8): 818-9.

Chew FL, Soong TK, Shin HC, et al. Topical piperacillin/tazobactam for recalcitrant pseudomonas aeruginosa keratitis. Journal of Ocular Pharmacolology and Therapeutics 2010; 26: 219–22.

Jain R, Murthy SI, Motukupally SR. Clinical outcomes of corneal graft infections caused by multi-drug resistant Pseudomonas aeruginosa. Cornea 2014; 33: 22–6.

Jain R, Murthy SI, Motukupally SR, et al. Use of topical colistin in multiple drug-resistant Pseudomonas aeruginosa bacterial keratitis. Cornea 2014; 33: 923–7.

Pande R, Bhailume PV. Use of topical meropenem in management of hospital acquired Pseudomonas ocular infections. Journal of Clinical Ophthalmolology and Research 2014; 2:23–5.

Sawusch MR, O’Brien TP, Valentine J, et al. Topical imipenem therapy of aminoglycoside-resistant pseudomonas keratitis in rabbits. American Journal of Ophthalmology 1988; 106: 77-81.

Castro Balado A, García Otero X, Zarra Ferro I, et al. 3PC-034 imipenem-fortified eye drops for the treatment of bacterial keratitis: development and characterisation. European Journal of Hospital Pharmacy 2019; 26: A52.

Cutarelli PE, Lazarus HM, Jacobs MR, et al. Antimicrobial activity and in vitro corneal epithelial toxicity of antimicrobial agents for gram-positive corneal pathogens. Current Eye Research. 1993; 12(7): 603-8.





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