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      Achromobacter xylosoxidans Keratitis after Contact Lens Usage

      case-report

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          Abstract

          To report on Achromobacter xylosoxidans keratitis in two healthy patients who had worn contact lenses foran extended period of time. A 36-year-old female and a 21-year-old female visited our hospital with ocular pain and blurred vision. Both patients had a history of wearing soft contact lenses for over fve years with occasional overnight wear. At the initial presentation, a slit lamp examination revealed corneal stromal infiltrations and epithelial defects with peripheral neovascularization in both patients. Microbiological examinations were performed from samples of corneal scrapings, contact lenses, contact lens cases, and solution. The culture resulting from the samples taken from the contact lenses, contact lens cases, and solution were all positive for Achromobacter xylosoxidans. Confrming that the direct cause of the keratitis was the contact lenses, the frst patient was prescribed ceftazidime and amikacin drops sensitive to Achromobacter xylosoxidans. The second patient was treated with 0.3% gatifoxacin and fortifed tobramycin drops. After treatment, the corneal epithelial defects were completely healed, and subepithelial corneal opacity was observed. Two cases of Achromobacter xylosoxidans keratitis were reported in healthy young females who wore soft contact lenses. Achromobacter xylosoxidans should be considered a rare but potentially harmful pathogen for lens-induced keratitis in healthy hosts.

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          Most cited references24

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          Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003).

          Achromobacter and Alcaligenes are emerging infectious gram-negative bacterial species that can affect immunosuppressed patients. The authors sought to determine the incidence and characteristics of bloodstream infections caused by these organisms in patients with underlying malignancies. All consecutive episodes of hematogenous Achromobacter and Alcaligenes infections recorded from December 26, 1989, to July 27, 2003, were studied retrospectively. Fifty-two episodes occurred in 46 patients; 31 patients (67%) had hematologic malignancies, and 24 (52%) experienced neutropenia ( 16), and use of mechanical ventilation and pressor support were significantly higher in patients who died (P < 0.001). Logistic regression analysis revealed that sepsis syndrome and high APACHE II scores were predictors of increased 30-day mortality. Most infections caused by this group of nonfermentative gram-negative bacteria were attributable to Ach. xylosoxidans, and only one-third were acquired during hospitalization. The presence of sepsis syndrome has evolved as an independent predictor of poor outcome in patients with high-risk malignancies accompanied by Achromobacter bloodstream infections.
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            Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases.

            Fifty-four cases of Achromobacter xylosoxidans bacteremia diagnosed over a 10-year period in patients from 2 months to 87 years of age were reviewed. Fifty-two episodes were nosocomial. The most frequent underlying condition was neoplasm (solid or hematological). The source of infection was a contaminated intravenous catheter in 35 patients (60%) and pneumonia in 6 patients. Eight (15%) patients died. The only risk factors significantly associated with mortality were age over 65 years and neutropenia. The results of in vitro susceptibility studies of the isolates showed that antibiotic therapy with antipseudomonal penicillins or carbapenems would be a reasonable choice. An epidemiological study conducted in the hemodialysis unit showed Achromobacter xylosoxidans in tap water and on the hands of two healthcare workers but not in the hemodialysis systems. Patients were probably contaminated when healthcare workers manipulated the intravenous catheters without wearing gloves.
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              Achromobacter xylosoxidans n. sp. from human ear discharge.

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                Author and article information

                Journal
                Korean J Ophthalmol
                KJO
                Korean Journal of Ophthalmology : KJO
                The Korean Ophthalmological Society
                1011-8942
                2092-9382
                February 2012
                14 January 2012
                : 26
                : 1
                : 49-53
                Affiliations
                Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea.
                Author notes
                Jae Woong Koh, MD, PhD. Department of Ophthalmology, Chosun University College of Medicine, #588 Seoseok-dong, Dong-gu, Gwangju 501-140, Korea. Tel: 82-62-220-3190, Fax: 82-62-225-9839, clearcornea@ 123456paran.com
                Article
                10.3341/kjo.2012.26.1.49
                3268169
                22323886
                af9ca036-c498-4c4b-8da9-a25829c40ca2
                © 2012 The Korean Ophthalmological Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 January 2011
                : 19 March 2011
                Categories
                Case Report

                Ophthalmology & Optometry
                hydrophilic contact lenses,achromobacter xylosoxidans,keratitis
                Ophthalmology & Optometry
                hydrophilic contact lenses, achromobacter xylosoxidans, keratitis

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