Colistin 점안액을 사용하여 성공적으로 치료한 다약제내성 녹농균에 의한 각막궤양 1예

A Case of Successful Treatment Using Topical Colistin in Multidrug-resistant Pseudomonas aeruginosa Bacterial Ulcer

목적: 장기입원하고 있던 환자에서 다약제내성 녹농균에 의한 각막궤양이 발생하여 Colistin 점안액을 이용해 성공적으로 치료한 1예를 보고하고자 한다. 증례요약: 타 병원에서 뇌동맥류출혈로 장기 입원 중이던 와병상태 58세 여자 환자가 좌안 충혈 및 분비물로 치료 중 증상이 호전되지 않아 본원으로 의뢰되었다. 내원 당시 의사소통이 되지 않고 안과적 검사에 협조가 되지 않았으나, 휴대용 세극등검사상 각막부종, 각막침윤, 각막혼탁, 결막충혈, 결막부종 및 앞방축농이 관찰되어, 각막 및 결막에서 배양검사를 시행하였고, 항생제 감수성 검사 결과 colistin을 제외한 모든 약제에서 내성을 보이는 다약제내성 녹농균으로 보고되었다. 즉시 한 시간마다 국소 colistin 0.19% 점안을 시작하였으며, colistin 치료 28일째, 각막혼탁만을 남긴 후 각막궤양은 관해되었고 일 년 후의 경과관찰에서도 재발소견은 나타나지 않았다. 결론: 와병상태로 자칫 적절한 검사 및 치료시기를 놓칠 뻔한 다약제내성 녹농균에 의한 각막궤양 환자를 colistin 점안액을 사용해 각막천공 등의 심각한 합병증 없이 성공적으로 치료하여 보고하는 바이다.

Purpose: To report a successful case of corneal ulcer caused by multidrug-resistant Pseudomonas aeruginosa using topical colistin in an immobilized patient who was hospitalized for a long period. Case summary: An immobilized 58-year-old female who was admitted for a long stay due to cerebral aneurysm hemorrhage presented with left ocular discharge and hyperemia, and was referred to our clinic. The patient was treated at a local clinic with topical antibiotics, but showed no improvement. At initial visit, she had difficulty communicating with the medical team and taking ophthalmic examination, and she had severe chemosis and corneal infiltration, corneal opacity, and hypopyon on her left eye with a portable slit lamp. Gram staining, bacterial and fungal cultures, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Pseudomonas aeruginosa, which is resistant to all antibiotics except colistin. As soon as we were aware of the results of the antibiotic sensitivity test, she was treated with topical colistin 0.19% every 1 hour on her left eye, starting immediately. After 28 days of treatment, the infection was resolved except for the remaining corneal opacity. She had a persisted stable corneal lesion at 1-year-follow up after colistin treatment, which indicated no recurrence. Conclusions: Due to gait disturbance, the patient almost missed appropriate ophthalmic examination or treatment. However, as we started immediate topical colistin treatment, we report a successful therapy of corneal ulcer induced by multidrug-resistant Pseudomonas aeruginosa without severe complications, such as perforation.