PDF
ePub
Citation
Print
Abstract
Purpose
To identify the clinical manifestations and risk factors for poor visual outcome, as well as antibiotic susceptibility of isolates in bacterial keratitis.
Methods
A total of 128 eyes in 128 patients with bacterial keratitis, who were diagnosed by smears and cultures from January 2000 to December 2007 were reviewed retrospectively. Sex, age, previous ocular disease, trauma history, pre-treatment duration, previous ocular surgery, clinical manifestation, causative bacteria, pre- and post-treatment visual acuity, and treatment results were evaluated. An initial univariate and multivariate logistic regression analysis was performed to identify and select the main prognostic factors. The antibiotic susceptibility was evaluated in 2 consecutive 4-year periods.
Results
The mean age of the 128 patients was 59.0±18.2 years; 67 (52.3%) patients were male. The most common risk factor was ocular trauma (40.6%). The most prevalent isolate was coagulase-negative Staphylococcus (43.7%). Large size (p <0.001) and previous ocular disease (p<0.001) were significant prognostic factors in the multivariate logistic regression model. Resistance of cefazolin and aminoglycoside antibiotics that were commonly used as a combination therapy increased over the 8 years, but there was no significant difference in the 2 time periods tested (all p >0.05). Among the fluoroquinolone antibiotics, susceptibility of ciprofloxacin was 75.7%.
References
1. Erie JC, Nevitt MP, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol. 1993; 111:1665–71.
2. Wilhelmus KR. Review of clinical experience with microbial keratitis associated with contact lens. CLAO J. 1987; 13:211–4.
3. Jones DB. Decision-making in the management of microbial keratitis. Ophthalmology. 1981; 88:814–20.
4. Blanton CL, Rapuano CJ, Cohen EJ, Laibson PR. Initial treatment of microbial keratitis. CLAO J. 1996; 22:136–40.
5. Afshari NA, Ma JJ, Duncan SM, et al. Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis. J Ocul Pharmacol Ther. 2008; 24:217–23.
6. Snyder ME, Katz HR. Ciprofloxacin resistant bacterial keratitis. Am J Ophthalmol. 1992; 114:336–8.
7. Gelender H, Rettich C. Gentamicin-resistant Pseudomonas aeruginosa corneal ulcers. Cornea. 1984; 3:21–6.
8. Hahn YH, Hahn TW, Choi SH, et al. Epidemiology of infectious keratitis (I): a multicenter study. J Korean Ophthalmol Soc. 1998; 39:1633–51.
9. Hahn YH, Hahn TW, Tchah HW, et al. Epidemiology of infectious keratitis (II): a multicenter study. J Korean Ophthalmol Soc. 2001; 42:247–65.
10. Hahn YH, Lee SJ, Hahn TW, et al. Antibiotic susceptibilities of ocular isolates from patients with bacterial keratitis: a multicenter study. J Korean Ophthalmol Soc. 1999; 40:2401–10.
11. Mukerji N, Vajpayee RB, Sharma N. Technique of area measurement of epithelial defects. Cornea. 2003; 22:549–51.
12. McLeod SD, Kolahdouz-Isfahani A, Rosamian K, et al. The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis. Ophthalmology. 1996; 103:23–8.
13. Ly CN, Pham JN, Badenoch PR, et al. Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluouroquinolones and gentamicin plus cephalothin. Clin Experiment Ophthalmol. 2006; 34:44–50.
14. Yeh DL, Stinnett SS, Afshari NA. Analysis of bacterial cultures in infectious keratitis, 1997 to 2004. Am J Ophthalmol. 2006; 142:1066–8.
15. Bourcier T, Thomas F, Borderie V, et al. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol. 2003; 87:834–8.
16. Yilmaz S, Ozturk I, Maden A. Microbial keratitis in West Anatolia, Turkey: a retrospective review. Int Ophthalmol. 2007; 27:261–8.
17. Wong T, Ormonde S, Gamble G, McGhee CN. Severe infective keratitis leading to hospital admission in New Zealand. Br J Ophthalmol. 2003; 87:1103–8.
18. Katz NN, Wadud SA, Ayazuddin M. Corneal ulcer disease in Bangladesh. Ann Ophthalmol. 1983; 15:834–6.
19. Fong CF, Hu FR, Tseng CH, et al. Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan. Am J Ophthalmol. 2007; 144:682–9.
20. Keay L, Edwards K, Naduvilath T, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology. 2006; 113:109–16.
21. Green M, Apel A, Stapleton F. Risk factors and causative organisms in microbial keratitis. Cornea. 2008; 27:22–7.
22. Green M, Apel A, Stapleton F. A longitudinal study of trends in keratitis in Australia. Cornea. 2008; 27:33–9.
23. Toshida H, Kogure N, Inoue N, Murakami A. Trends in microbial keratitis in Japan. Eye Contact Lens. 2007; 33:70–3.
24. Miedziak AI, Miller MR, Rapuano CJ, et al. Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology. 1999; 106:1166–71.
25. Musch DC, Sugar A, Meyer RF. Demographic and predisposing factors in corneal ulceration. Arch Ophthalmol. 1983; 101:1545–8.
26. McLeod SD, LaBree LD, Tayyanipour R, et al. The importance of initial management in the treatment of severe infectious corneal ulcers. Ophthalmology. 1995; 102:1943–8.
27. Morlet N, Minassian D, Butcher J, et al. Risk factors for treatment outcome of suspected microbial keratitis. Br J Ophthalmol. 1999; 83:1027–31.
28. Bower KS, Kowalski RP, Gordon YJ. Fluoroquinolone in the treatment of bacterial keratitis. Am J Ophthalmol. 1996; 121:712–5.
29. Jhanji V, Sharma N, Satpathy G, et al. Fourth generation fluoroquinolone resistant bacterial keratitis. J Cataract Refract Surg. 2007; 33:1488–9.
30. Moshirfar M, Mirzaian G, Feiz V, Kang PC. Fourth generation fluoroquinolone resistant bacterial keratitis after refractive surgery. J Cataract Refract Surg. 2006; 23:515–8.
31. Alexandrakis G, Alfonso EC, Miller D. Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones. Ophthalmology. 2000; 107:1497–502.
32. Smitha S, Lalitha P, Prajna VN, Srinivasan M. Susceptibility trends of Pseudomonas species from corneal ulcers. Indian J Med Microbiol. 2005; 23:168–71.
33. Pachigolla G, Blomquist P, Cavanagh HD. Microbiologic keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in North Texas. Eye Contact Lens. 2007; 33:45–9.
34. Kowal VO, Levey SB, Laibson PR, et al. Use of routine antibiotic sensitivity testing for the management of corneal ulcers. Arch Ophthalmol. 1997; 115:462–5.
Table 1.
Prevalence of the micro-organisms isolated from corneal cultures of eyes diagnosed with bacterial keratitis
| organism | 2000∼2003 n* (%) | 2004∼2007 n (%) | Total n (%) |
|---|---|---|---|
| Gram-positive bacteria | |||
| Staphylococcus aureus | 9 (5.3) | 3 (2.4) | 12 (7.7) |
| Staphylococcus epidermidis | 19 (11.2) | 24 (14.2) | 43 (25.4) |
| Other coagulase-negative staphylococci | 21 (12.4) | 9 (5.3) | 30 (17.7) |
| Viridans streptococcus | 13 (7.7) | 3 (1.8) | 16 (9.5) |
| Streptococcus pneumonia | 4 (2.4) | 8 (4.7) | 12 (7.1) |
| Enterococcus faecalis | 0 (0.0) | 2 (1.2) | 2 (1.2) |
| Other streptococcus | 2 (1.2) | 1 (0.6) | 3 (1.8) |
| bacillus species | 2 (1.2) | 2 (1.2) | 4 (2.4) |
| Gram-positive rod | 4 (2.4) | 8 (4.7) | 12 (7.1) |
| Subtotal | 74 (80.4) | 60 (79.2) | 134 (79.9) |
| Gram-negative bacteria | |||
| Pseudomonas aeruginosa | 6 (3.5) | 3 (1.8) | 9 (5.3) |
| Burkholderia cepacia | 2 (1.2) | 2 (1.2) | 4 (2.4) |
| Serratia marcescens | 2 (1.2) | 3 (1.8) | 5 (3.0) |
| Klebsiella species | 4 (2.4) | 0 (0.0) | 4 (2.4) |
| Proteus species | 0 (0.0) | 3 (1.8) | 3 (1.8) |
| Enterobacter clocae | 2 (1.2) | 0 (0.6) | 2 (1.8) |
| Sphingomonas paucimobilis | 0 (0.0) | 1 (0.6) | 1 (0.6) |
| Alcaligenes faecalis | 0 (0.0) | 1 (0.6) | 1 (0.6) |
| Morganella morganii | 0 (0.0) | 1 (0.6) | 1 (0.6) |
| Acinetobacter baumanii | 0 (0.0) | 1 (0.6) | 1 (0.6) |
| Providencia rettgeri | 1 (0.6) | 0 (0.0) | 1 (0.6) |
| Other non-fermentating bacilli | 1 (0.6) | 0 (0.0) | 1 (0.6) |
| Subtotal | 18 (19.6) | 15 (20.8) | 33 (20.1) |
| Total | 92 (100.0) | 75 (100.0) | 167 (100.0) |
Table 2.
Comparison of demographic characteristics between the treatment success and failure groups
| Treatment success | Treatment failure | p value | |
|---|---|---|---|
| Age (yrs) | 56.00±20.47 | 63.71±12.80 | 0.001 |
| Pretreatment symptom duration | 3.95±3.45 | 4.78±4.48 | 0.226 |
| Hypopyon height (mm) | 0.72±0.42 | 1.36±0.82 | 0.002 |
| Ulcer size (mm2) | 3.9±4.6 | 12.3±11.5 | <0.001 |
| Initial VA* (LogMAR) | 1.19±0.90 | 2.16±0.98 | <0.001 |
Table 3.
Significant predictors for treatment failure in bacterial keratitis (Univariate analysis)
Table 4.
Significant predictors for treatment failure in bacterial keratitis (Multivariate analysis)
| Variable | Odds ratio | 95% CI* | p value |
|---|---|---|---|
| Age | 2.653 | 0.964∼6.918 | 0.059 |
| Deep infiltration | 1.089 | 0.638∼10.593 | 0.182 |
| Hypopyon | 0.652 | 0.303∼2.471 | 0.787 |
| Previous ocular history | 0.140 | 0.037∼0.398 | <0.001 |
| Size of ulcer | 9.729 | 2.984∼23.799 | <0.001 |
Table 5.
Antibiotic susceptibility profiles for isolates recovered from bacterial culture in all cases from 2000 to 2007
Table 6.
Antibiotic susceptibility pattern of Gram-positive bacteria from bacterial keratitis case grouped into two four-year study periods
Table 7.
Antibiotic susceptibility pattern of Gram-negative bacteria from bacterial keratitis cases, grouped into two four-year study periods
Table 8.
Antibiotic susceptibility pattern of Staphylococcus epidermidis from bacterial keratitis cases, grouped into two four-year study periods
|
2000 to 2003 |
2004 to 2007 |
2000 to 2007 |
p value | ||||
|---|---|---|---|---|---|---|---|
| Susceptible n (%) | Resistant n (%) | Susceptible n (%) | Resistant n (%) | Susceptible n (%) | Resistant n (%) | ||
| S. epidermis | |||||||
| Oxacillin | 8 (47.1) | 9 (52.9) | 10 (45.5) | 12 (54.5) | 18 (46.2) | 21 (53.8) | 0.921 |
| Cefazolin | 8 (66.7) | 4 (33.3) | 0 (0) | 0 (0) | 8 (66.7) | 4 (33.3) | -* |
| Vancomycin | 17 (100) | 0 (0) | 22 (100) | 0 (0) | 39 (100) | 0 (0) | -* |
| Ciprofloxacin | 15 (78.9) | 4 (21.1) | 17 (73.9) | 6 (26.1) | 32 (76.2) | 10 (23.8) | 0.496 |
Table 9.
Antibiotic susceptibility pattern of Pseudomonas aeruginosa from bacterial keratitis cases, grouped into two four-year study periods
XML Download