BMJ Case Reports 2018; doi:10.1136/bcr-2018-225163
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

The successful treatment of a multidrug-resistant Achromobacter xylosoxidans corneal ulcer with topical meropenem

  1. Kieren Darcy1
  1. 1Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK
  2. 2Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Shokufeh Tavassoli, shokufeh_tavassoli{at}
  • Accepted 24 June 2018
  • Published 18 July 2018


Microbial keratitis is a common corneal condition, with many known risk factors. We present a case of an 88-year-old female patient with a multidrug-resistant Achromobacter xylosoxidans corneal ulcer in a previously failed second penetrating keratoplasty, successfully managed with topical meropenem drops administered hourly around the clock, for five days preceding and then hourly day only, for five days following a repeat third penetrating keratoplasty. Topical meropenem 50 mg/mL was prepared by mixing a 500 mg vial of meropenem with 10 mL of sterile water with pharmacy advice that administration should be within an hour. To the best of our knowledge, this is the first report of the use of topical meropenem in the management of A.xylosoxidans keratitis. This case highlights the importance of the mean inhibitory concentrations for antibiotics when considering sensitivities. Topical meropenem may be a useful treatment option for multidrug-resistant bacterial corneal ulcers that are resistant to conventional therapy.


  • Contributors ST: wrote the manuscript. DG: assisted with the editing of the manuscript. MW: assisted with the editing of the manuscript and provided microbiological advice. KD: assisted with the editing of the manuscript, was responsible for the care of the patient and made the decision to perform the final surgery with the use of the meropenem treatment discussed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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