Nocardia asteroides Keratitis Resistant to Amikacin

Purpose: To describe 2 cases of Nocardia keratitis resistant to topical compounded amikacin therapy. Methods: A 24-year-old woman presented with a corneal infiltrate. Cultures were taken, and topical moxifloxacin was administered. Corneal biopsy was performed when clinical status deteriorated, which confirmed infection with Nocardia. The patient was administered topical compounded amikacin. When clinical status further deteriorated, she was switched to compounded trimethoprim–sulfamethoxazole, which resulted in rapid resolution. Separately, a 22-year-old woman presented with contact lens–related keratitis that grew Nocardia asteroides. Corneal cultures and drug sensitivity testing revealed a strain of N. asteroides resistant to amikacin and imipenem, but sensitive to tobramycin. After a protracted clinical course, the keratitis ultimately responded to topical tobramycin leaving the patient with a pericentral corneal scar. Conclusions: Nocardia keratitis is an atypical infection for which standard management algorithms exist. However, atypical cases require that these patients be followed closely for the response to therapy.