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Presentation type	E-poster
Title	Atypical Bacterial Keratitis treated with Atypical Antibiotics – Clinical Application and Outcome of topical Amikacin, Azithromycin and Linezolid drops

Purpose	To describe three cases of atypical bacterial keratitis occurring after previous ocular trauma or surgery, with clinical non-response to conventional fortified antibiotic therapy.
Methods	Three patients with bacterial keratitis and a history of previous ocular trauma or surgery were retrospectively reviewed. All patients demonstrated an inadequate clinical response to conventional fortified topical antibiotics. Microbiological cultures and antimicrobial susceptibility testing were performed. Based on the identified pathogens and their susceptibility profiles, individually compounded topical antibiotics were prepared at Ghent University Hospital in collaboration with the hospital pharmacy. The treatment regimens included amikacin, azithromycin, and/or linezolid eye drops
Results	In 2 of the 3 cases, microbiological analysis identified atypical bacterial pathogens, including a non-tuberculous mycobacterium (Mycobacterium chelonae-like) and Nocardia nova. Following initiation of targeted compounded antibiotic therapy, progressive clinical improvement was observed, resulting in a favourable visual outcome in all but one case.
Conclusion	These cases highlight the importance of maintaining a high index of suspicion for atypical bacterial pathogens in Keratitis following ocular trauma or surgery, particularly when there is an inadequate response to conventional fortified antibiotics. Failure of standard therapy should prompt early microbiological investigation, including culture and susceptibility testing, and consideration of “atypical” antimicrobial agents. Early recognition and targeted treatment may be crucial in achieving resolution of infection and preserving visual function.
Conflict of interest	No

Authors 1

Last name	NAESSENS
Initials	N
Department	Ophthalmology
City	Ghent

Authors 2

Last name	KREPS
Initials	E
Department	Ophthalmology
City	Ghent

Authors 3

Last name	HOUBEN
Initials	I
Department	Ophthalmology
City	Ghent

Authors 4

Last name	HUYS
Initials	L
Department	Pharmacy
City	Ghent

Authors 5

Last name	ROELS
Initials	D
Department	Ophthalmology
City	Ghent