Clinical and microbiological profile of infectious keratitis in an area of Madrid, Spain

Purpose To study the clinico-microbiological profile, outcomes and prognostic factors of post penetrating keratoplasty (PKP) infectious keratitis. Methods Retrospective review of medical records of 78 patients with post PKP infectious keratitis presenting between January 2014 and December 2018. Demographic, clinical and microbiological profile was documented and predictors of treatment and graft success were evaluated using univariate and subsequent multivariate logistic regression analysis. Results Mean age of patients was 52.17 ± 15.51 years and mean infiltrate size was 19.39 ± 19.68 mm2. Mean duration of presentation with infection post PKP was 11.66 ± 10.65 months. Culture positivity was seen in 64 eyes (82.05%). Bacterial growth was observed in 47 eyes (60.25%), fungal growth in 17 (21.79%) and no microbiological growth in 14 eyes (17.94%). At 3 months the visual acuity (VA) improved in 37 eyes (47.44%), did not change in 27 (34.62%) and deteriorated in 14 (17.95%). Graft failure was noted in 53 eyes (73.08%). Surgical intervention was needed in 47 (60.25%) eyes of which most common was therapeutic PKP in 32 eyes (41.02%). Treatment failure was noted with fungal infection ( p = 0.05), poorer vision at presentation ( p = 0.02), larger infiltrate area ( p = 0.002) and graft infection developing before 1 year ( p = 0.02). Graft failure was noted with associated endophthalmitis ( p = 0.02), poorer VA at presentation ( p = 0.01) and larger infiltrate area ( p = 0.02). Conclusion Post PKP infectious keratitis is a sight threatening ocular condition. It is associated with high incidence of graft failure and frequently requires surgical intervention. Fungal etiology, larger infiltrate size, poorer vision at presentation and associated endophthalmitis carries a poorer prognosis.

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Microbiological Profile of Infectious Keratitis in a Portuguese Tertiary Centre

Journal of Ophthalmology ◽

10.1155/2019/6328058 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Cláudia Oliveira-Ferreira ◽

Mariana Leuzinger-Dias ◽

João Tavares-Ferreira ◽

Luís Torrão ◽

F. Falcão-Reis

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Streptococcus Pneumoniae ◽

High Sensitivity ◽

Infectious Keratitis ◽

Adequate Treatment ◽

Microbiological Profile ◽

Tertiary Centre ◽

Tertiary Center

The microbiological profile of infectious keratitis has shown great differences across the world. Due to the continuous shifting trends in microbiological profile and antibiotic resistance patterns reported in several studies, constant local updates are crucial to provide an adequate treatment. The propose of this study was to analyze the incidence of infectious keratitis, possible changing trends in microbiological profile, and bacteria sensitivity to commonly used antibiotics, in our tertiary center, in the last 10 years. A retrospective study was performed, based on the survey review of electronic medical records of all patients with presumed infectious keratitis, between January 1, 2009, and December 31, 2018. Microbial cultures were performed, and patients were treated according to an internal protocol. A total of 1360 samples were included. We obtained a 35.1% culture-positive rate. Bacteria accounted for 76.78% of all positive scrapes (53.34% were Gram positive and 23.44% were Gram negative), Acanthamoeba for 12.13%, fungi for 8.16%, and virus for 2.93%. The most frequent agent identified was Corynebacterium macginleyi (18.41%), followed by Staphylococcus aureus (17.78%), Streptococcus pneumoniae (9.41%), and Pseudomonas aeruginosa (9.00%). We identified at least one ophthalmologic risk factor in 410 patients (85.77%). Trauma and contact lens wear were the most common risk factors found, accounting for 34.94% (n = 167) and 33.47% (n = 160) of cases. Sensitivity to fluoroquinolones and aminoglycosides was tested in all bacterial isolates, presenting values of 96.66% and 98.12%. In our region, the most common bacteria are Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa, and they showed high sensitivity rates to first-line antibiotics, without any modification or emergence of antibiotic resistance trends during the 10 years of the study. For this reason, we decided to maintain the same internal protocol in our tertiary centre.

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