Stenotrophomonas Maltophilia Keratitis: Two Cases Of Superinfection In Compromised Corneas.
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR213 | Type: Poster | DOI: 10.82333/kp4n-h527
Authors: Dr Tomás Hernández-García* 1 , Dr Alicia Albaladejo-Herreros 1 , Dr Lucas Moura-Bastos 1 , Dr Josep Torras Sanvicens 1 , Dr Francisco Palma Carvajal 1
1Oftalmología,Hospital Clínic de Barcelona,Barcelona,Spain
Purpose
To report two cases of Stenotrophomonas maltophilia keratitis occurring as superinfections in compromised corneas and describe their clinical presentation, antibiotic susceptibility patterns, management challenges, and outcomes. S. maltophilia is an uncommon but challenging cause of infectious keratitis due to its intrinsic resistance to carbapenems and aminoglycosides. These cases highlight the importance of recognizing S. maltophilia as a potential pathogen in patients with pre-existing corneal disease and the need for culture-directed therapy given variable antibiotic susceptibility patterns.
Setting
Corneal Department, Institut Clínic d’Oftalmologia, Hospital Clínic de Barcelona. Spain.
Methods
Retrospective case series of two patients with culture-proven S. maltophilia keratitis. Clinical data including predisposing factors, presenting features, microbiological results with minimum inhibitory concentration (MIC) values, antibiotic susceptibility patterns, treatment regimens, and visual outcomes were analyzed. Both patients had significant pre-existing corneal pathology prior to developing S. maltophilia infection.
Results
Case 1: Patient with herpetic corneal leucoma (VA 0.2) developed a neurotrophic ulcer progressing to perforation (VA HM), treated with cyanoacrylate glue. Three months later presented endothelial failure, hypopyon and infiltrate. Culture grew abundant S. maltophilia, levofloxacin-sensitive. Targeted therapy achieved stabilization, with severe thinning and VA HM.
Case 2: Patient with advanced glaucoma developed corneal decompensation after DMEK (VA HM) and recurrent ulceration while awaiting repeat surgery. Culture isolated S. maltophilia (minocycline sensitive, TMP-SMX intermediate, levofloxacin resistant). Addition of fortified topical ceftazidime led to stabilization; eye progressed to prephthisis, currently stable, VA light perception.
Conclusions
S. maltophilia keratitis should be considered in patients with compromised corneal surfaces, particularly following surgical procedures or in the setting of pre-existing corneal disease. Antibiotic susceptibility is highly variable, with fluoroquinolone resistance documented in our series despite literature reporting high susceptibility rates. Culture-directed therapy is essential given unpredictable resistance patterns. Combination therapy including fortified ceftazidime may be beneficial in refractory cases. Visual prognosis remains guarded despite infection control, emphasizing the importance of early recognition and aggressive management of this opportunistic pathogen in vulnerable corneal tissue.