항생제 다제내성 아시네토박터 바우마니와 칸디다 파라프실로시스가 복합감염된 각막염 1예
A Case of Keratitis Caused by Combined Infection of Multidrug-Resistant Acinetobacter Baumannii and Candida Parapsilosis
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목적: 장기간 0.5% Levofloxacin과 0.1% Fluorometholone을 점안한 환자에서 다제내성 Acinetobacter baumannii와 Candida parapsilosis 에 복합감염된 각막염 1예를 경험하여 이를 보고하고자 한다. 증례요약: 무동성 무어증(akinetic mutism) 상태로 본원 신경외과에 입원 중인 55세 남자 환자가 좌안 결막 충혈과 눈곱을 주소로 안과로 의뢰되었다. 환자는 2년 전부터 0.5% Levofloxacin과 0.1% Fluorometholone을 점안하고 있었다. 좌안에서 불규칙한 모양(3.5×4.5mm)의 각막궤양이 관찰되었다. 각막에서 시행한 배양검사에서 다제내성 A. baumannii와 C. parapsilosis이 동정되었으며, 항생제 감수성 검사를 토대로 10% Piperacillin/Tazobactam과 0.125% Amphotericin B 점안액을 초기에는 1시간 간격으로 시작하여 감량하였다. 점안 8주째 각막궤양은 각막 혼탁을 남긴 후 치료되었다. 결론: 다제내성 A. baumannii와 C. parapsilosis에 의한 각막염 1예를 국내 최초로 경험하여 보고하는 바이다.
Abstract
Purpose: To report a case of keratitis caused by Acinetobacter baumannii and Candida parapsilosis in a patient using 0.5% levofloxacin and 0.1% fluorometholone for an extended period of time. Case summary: A 55-year-old male patient in the neurosurgery department with conjunctival injection and discharge in his left eye was consulted for ophthalmic evaluation and treatment. He was hospitalized in the state of akinetic mutism and given 0.5% levofloxacin and 0.1% fluorometholone for 2 years. On slit-lamp examination, a 3.5 × 4.5-mm dense stromal infiltrate with an overlying epithelial defect was observed. Corneal scraping culture revealed multidrug-resistant A. baumannii and C. parapsilosis. According to the susceptibility result, the patient was treated with topical 10% piperacillin/tazobactam and 0.125% amphotericin B hourly. The corneal ulcer healed gradually with corneal opacity remaining after 8 weeks of treatment. Conclusions: The authors of the present study report a case of treated multidrug-resistant A. baumannii and C. parapsilosis keratitis in a patient using topical antibiotics and steroid for an extended period of time.
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