Polymicrobial keratitis secondary to Burkholderia ambifaria, enterococcus, and staphylococcus aureus in a patient with herpetic stromal keratitis

Abstract

Purpose To report polymicrobial keratitis in a patient with herpetic stromal keratitis. The initial infecting organism, Burkholderia ambifaria, has not previously been reported to cause microbial keratitis. Methods Clinical evaluation and corneal culture were performed. Results A 59-year-old-man undergoing topical corticosteroid therapy for herpes simplex stromal keratitis developed corneal infection with B. ambifaria. The organism was reisolated 12 days after initiation of hourly therapy with topical levofloxacin 0.5%. At reculture Staphylococcus aureus and Enterococcus spp. were also isolated. The addition of topical amikacin and vancomycin led to resolution of the microbial keratitis. Conclusions Burkholderia ambifaria infected a compromised cornea, exhibited an unusual sensitivity profile, and remained viable after 12 days of therapy with an antibiotic to which it was sensitive by in vitro tests.