Nocardia asteroides Keratitis Resistant to Amikacin

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Nocardia keratitis is an uncommon ocular infection.
• Standard treatment protocols exist but may not be effective in all cases.

Observation:

• Two cases of Nocardia keratitis are presented.
• One patient initially received moxifloxacin, then compounded amikacin, and finally trimethoprim-sulfamethoxazole for resolution.
• Another patient with Nocardia asteroides keratitis resistant to amikacin and imipenem was treated with topical tobramycin.

Findings:

• Nocardia keratitis demonstrated resistance to topical compounded amikacin in both cases.
• Trimethoprim-sulfamethoxazole and tobramycin proved effective in resolving the infections.
• Drug sensitivity testing is crucial for guiding treatment in resistant Nocardia keratitis.

Implications:

• Atypical Nocardia keratitis cases necessitate close patient monitoring and potential adjustments to antimicrobial therapy.
• Standard management algorithms may need to be adapted based on individual Nocardia species and drug resistance patterns.
• Prompt identification and susceptibility testing are vital for successful outcomes in challenging Nocardia keratitis cases.