{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:55:23Z","timestamp":1790470523491,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,6,24]]},"abstract":"<jats:p>\n                    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\n                    <jats:italic>Achromobacter xylosoxidans<\/jats:italic>\n                    corneal ulcer in a previously failed second penetrating keratoplasty, successfully managed with topical meropenem drops administered hourly around the clock, for five\u2009days preceding and then hourly day only, for five\u2009days following a repeat third penetrating keratoplasty. Topical meropenem 50\u2009mg\/mL was prepared by mixing a 500\u2009mg vial of meropenem with 10\u2009mL 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\n                    <jats:italic>A.xylosoxidans<\/jats:italic>\n                    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.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2018-225163","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T12:06:52Z","timestamp":1531915612000},"page":"bcr-2018-225163","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["The successful treatment of a multidrug-resistant\n                    <i>Achromobacter xylosoxidans<\/i>\n                    corneal ulcer with topical meropenem"],"prefix":"10.1136","volume":"2018","author":[{"given":"Shokufeh","family":"Tavassoli","sequence":"first","affiliation":[{"name":"Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gunn","sequence":"additional","affiliation":[{"name":"Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.Martin","family":"Williams","sequence":"additional","affiliation":[{"name":"Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieren","family":"Darcy","sequence":"additional","affiliation":[{"name":"Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,7,18]]},"reference":[{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1348-0421.1971.tb00607.x"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.2","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e3181a1658f"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.3","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.02293-13"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.4","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jcrs.2006.06.041","article-title":"Bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty","volume":"32","author":"Srinivasan","year":"2006","journal-title":"J Cataract Refract Surg"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.5","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/00003226-198912000-00008","article-title":"Achromobacter xylosoxidans corneal ulcer in a therapeutic soft contact lens wearer","volume":"8","author":"Fiscella","year":"1989","journal-title":"Cornea"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.6","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.04260-14"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.7","doi-asserted-by":"crossref","unstructured":"Almenara Michelena C , del Buey Mar\u00eda \u00c1ngeles , Ascaso FJ , et al . Keratitis Due to Achromobacter xylosoxidans in a Contact Lens User. Eye Contact Lens 2017:1\u20134.doi:10.1097\/ICL.0000000000000370","DOI":"10.1097\/ICL.0000000000000370"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.8","doi-asserted-by":"crossref","first-page":"788","DOI":"10.3928\/1081597X-20130917-01","article-title":"Achromobacter xylosoxidans keratitis masquerading as recurrent erosion after LASIK","volume":"29","author":"Riaz","year":"2013","journal-title":"J Refract Surg"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.9","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1016\/j.jcrs.2012.08.022","article-title":"Mixed Acanthamoeba and multidrug-resistant Achromobacter xyloxidans in late-onset keratitis after laser in situ keratomileusis","volume":"38","author":"Arnalich-Montiel","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.10","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200868060-00006"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.11","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1869-5760-3-44","article-title":"Nocardia veterana endogenous endophthalmitis in a cardiac transplant patient","volume":"3","author":"Scott","year":"2013","journal-title":"J Ophthalmic Inflamm Infect"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/2320-3897.122637","article-title":"Use of topical meropenem in management of hospital acquired Pseudomonas ocular infections","volume":"2","author":"Pande","year":"2014","journal-title":"J Clin Ophthalmol Res"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.13","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.09-4638"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.14","unstructured":"European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 8.0, valid from 2018-01-01. checked on 7\/2\/18 http:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Breakpoint_tables\/v_8.0_Breakpoint_Tables.pdf."},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2009.08.015"},{"key":"2025082802481067000_2018.jul18_1.bcr-2018-225163.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-225163","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:48:19Z","timestamp":1756374499000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-225163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,18]]},"references-count":16,"alternative-id":["10.1136\/bcr-2018-225163"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-225163","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,18]]}}}