# Rare and in Your Chair: An Emerging Use of Meropenem in a Case of Klebsiella pneumoniae Endophthalmitis Following Cataract Surgery

## TL;DR

A rare case of antibiotic-resistant Klebsiella pneumoniae endophthalmitis after cataract surgery was successfully treated with meropenem, highlighting the need for tailored antibiotic use.

## Contribution

Demonstrates the emerging use of meropenem for ESBL-producing Klebsiella pneumoniae endophthalmitis.

## Key findings

- ESBL-producing Klebsiella pneumoniae caused chronic endophthalmitis after cataract surgery.
- Meropenem treatment, both IVT and intravenous, led to improved vision in the patient.
- Switching from conventional antibiotics to meropenem based on culture results was critical for recovery.

## Abstract

Postoperative endophthalmitis is an infrequent but devastating complication that can happen after cataract surgery. The current mainstays of bacterial endophthalmitis treatment are intravitreal (IVT) antibiotics and vitrectomy. We hereby report a rare case of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in chronic postcataract surgery endophthalmitis, which was treated successfully with IVT and intravenous meropenem. An elderly female patient who underwent an eventful cataract surgery with anterior chamber intraocular lens (ACIOL) insertion in the right eye (RE) presented with profound painful vision loss. Clinical examination revealed a drop in her visual acuity and intense inflammation in the RE anterior chamber (AC). She was treated for chronic postcataract surgery endophthalmitis based on clinical examination. IVT tapping was performed, and IVT conventional antibiotics (vancomycin/ceftazidime) were given. Subsequently, her antibiotics were substituted with meropenem and given IVT and intravenously based on vitreous tapping culture and sensitivity. Following treatment, her vision improved on her RE. This case was reported to highlight the importance of high index of suspicion among clinicians for the possibility of antibiotic resistance, and the significance of substituting conventional antibiotics with a more susceptible one may yield better outcomes.