Multi-Drug Resistant Citrobacter Koseri Corneal Ulcer Treated By Piperacillin-Tazobactam In A Tertiary Care Eye Hospital

To present a rare case of corneal ulcer by Citrobacter and its management.

case report

A 56-year-old man a known diabetic was referred to our emergency department with a nonhealing corneal ulcer for the last 4 weeks. On examination, there was a corneal ulcer measuring 7×7 mm and an anterior chamber hypopyon of 5 mm. Corneal scraping revealed the presence of polymorphs. The patient was started on topical empirical fortified antibiotic eye drops vancomycin 5% and tobramycin 1.3%. The culture and sensitivity report at 72 hours showed growth of Citrobacter Koseri, which was resistant to all the antibiotics but piperacillin and tazobactam. 

The patient was started on eyedrop piperacillin and tazobactam 10% hourly along with atropine eyedrops. The patient showed significant improvement after therapy after therapy. Intracameral wash was also given with piperacillin and tazobactam antibiotics and the patient was started on topical steroid therapy. There was a nonhealing epithelial defect which was managed with amniotic membrane transplantation and tarsorraphy.

Citrobacter koseri is a rare cause of microbial keratitis in poorly controlled diabetes mellitus patients.