녹농균, 아시네토박토 바우마니, 오크로박트럼 안트로피 복합감염에 의한 각막염
Polymicrobial Keratitis of Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi
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목적: 녹농균, 아시네토박토 바우마니, 오크로박트럼 안트로피 복합감염 1예를 보고하고자 한다. 증례요약: 53세 여자가 내원 6주 전부터 우안에 통증, 불편감이 발생하였고 내원 7일 전 피부과 스테로이드 연고를 안검에 도포한 후 증상이 악화되어 내원하였다. 초진 시력은 광각 인지로 세극등에서 전방축농, 고리모양의 중심부 각막궤양이 관찰되었다. 배양검사를 시행 후 0.5% moxifloxacin, 2% voriconazole, 1% cyclopentolate를 점안하도록 하였다. 배양 결과 녹농균, 아시네토박토 바우마니가 동정되어 감수성 결과에 따라 5% ceftazidime을 추가하였다. 이후 각막염이 호전되어 점안 치료를 유지하였으나 다시 각막염이 악화되는 소견을 보여 2차 배양검사를 실시하였다. 배양검사에서 오크로박트럼 안트로피가 새롭게 동정되어 감수성을 보인 1.4% gentamicin을 추가 점안하도록 하였다. 이후 각막염은 호전되는 경과를 보였으나 천공의 위험이 높아 결막피판술을 시행하고 안정화되었다. 결론: 녹농균, 아시네토박토 바우마니, 오크로박트럼 안트로피 균주에 의한 복합감염을 국내에서 최초로 경험하였기에 이를 보고하는 바이다.
Abstract
Purpose: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. Case summary: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. Conclusions: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.
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