Microbial Keratitis Patients Research Articles

Risk Factors and Microbiological Features of Patients Hospitalized for Microbial Keratitis

We conducted a retrospective, cross-sectional study to analyze predisposing factors, clinical features, and microbiological characteristics of patients with microbial keratitis hospitalized over 10 years.The medical records of 558 patients who were diagnosed with microbial keratitis and admitted to Chang Gung Memorial Hospital (CGMH), a referral center in Taiwan, from January 1, 2003 to December 31, 2012 were reviewed. Demographics, predisposing factors, isolated organisms, treatment, and hospital stay were recorded. Yearly trends were tested using a linear-by-linear association.Contact lens wear was the most common predisposing factor (31.4%), followed by ocular and systemic diseases (26.3%) and trauma (23.5%). Contact lens-related infectious keratitis increased year by year (P = 0.011). Pseudomonas aeruginosa was the most commonly isolated organism (28%), followed by fungi (17.6%) and coagulase-negative Staphylococcus (5.4%). Except for Serratia marcescens, the identified organisms did not change over 10 years. Most bacterial infections were controlled using antimicrobial treatment, but more than half of patients with fungal keratitis required surgical interventions. The mean hospital stay was 13.7 ± 11.5 days. Previous ocular surgery, large ulcer size, nontuberculous myycobacteris infection, and surgery during admission were related to prolonged hospital stay.In Taiwan, contact lens-related pseudomonal keratitis remained the most common cause of microbial keratitis in patients hospitalized from 2003 to 2012.

English

The aim of the present study was to identify the prevalence of non-viral etiological agents, their geographic, climatic and occupational risk factors associated with microbial keratitis in patients of Kannauj district of Uttar Pradesh, India. Microbial keratitis is a leading cause of monocular blindness world-wide. This study was conducted to find out the epidemiological factors associated with this disease in our set up. METHOD: A prospective analysis of 250 clinically diagnosed cases coming to OPD of Govt. Medical College, Kannauj were examined over a period of one year, from 1st January 2013 to 31 st December 2013. Age, Sex, Occupation, Agents leading to the ulcer were some of the parameters included in our study. Corneal scrapes were collected and subjected to microscopy, culture and sensitivity. RESULTS: In 250 patients of clinically diagnosed microbial keratitis, 153(61.2%) were Males and 97(38.8%) Females. Most common Age group was 41-60 yrs. (40.8%) followed by 21-40 yrs. (39.2%). Most common cause of Microbial keratitis was Ocular Trauma. Among the microbial keratitis fungal ulcer were more frequent due to trauma by Organic Vegetative matter and as Kannauj is rural area, so Farmers were mostly affected (54%). CONCLUSION: Microbial keratitis is mostly seen in Farmers in this part of India. Males are affected more than Females. Aspergillus and staphylococcus aureus were the most common causative agents. Increased prevalence of Microbial keratitis was seen during harvest and post-harvest seasons.

Risk factors for contact lens‐related microbial keratitis: A case‐control multicenter study

AbstractPurpose The most feared complication of contact lens (CL) wear is microbial keratitis (MK), even though its incidence remains low. While CL materials and replacement schedules have developed greatly in recent years, the risk of MK, however, has not been reduced in users of daily disposable and silicone hydrogel CL. This study aimed to identify the risk factors of CL‐related MK while putting into perspective individual patients’ risks and societal burdens.Methods A multicenter case‐control study was designed. The CL‐related MK subpopulation (Case) was compared to healthy CL wearers (Control) using a complete a 52‐item anonymous questionnaire designed to determine subject demographics and lens wear history. Univariate and multivariate logistic regression analyses were performed in order to compare both groups.Results The study enrolled 508 cases and 499 controls, and revealed a higher risk for MK patients wearing soft CL, with cosmetic CL, with overnight wear, exceeding the CL‐ or the cleaning solution replacement delay, using a multipurpose cleaning solution. On the contrary, hyperopia, fitting and follow‐up by an ophthalmologist, and respect of basic hygiene rules were protective against CL‐related MK.Conclusion The infectious determinants were linked to the patient, type of lenses, hygiene routine, CL handling, cleaning solution, and storage case. This study aimed to highlight the increasingly documented CL‐associated complications, which likely occur due to insufficient health professional supervision and lack of patient information regarding basic rules of hygiene, as well as CL care and handling.

Epidemiology and medical prediction of microbial keratitis in southeast Brazil

The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis. A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded. Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61%. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p<0.0001). Coexisting systemic diseases, ocular diseases, and previous ocular surgery were more frequent among BK cases (p=0.001; p=0.001; p=0.004; respectively). The following clinical findings were more frequent in bacterial keratitis: hypopion, corneal peripheral superficial vascularisation, and ulceration area >20 mm² (p<0.05). The diagnosis was predicted correctly in 81.6% of bacterial keratitis cases and in 48.1% of fungal keratitis cases. Medical judgment of microbial keratitis agent is possible based on clinical and epidemiological data, but it is more difficult for fungal infection. Thus, such data cannot be the only basis for the diagnosis of suspected microbial keratitis, but oriented clinical suspicion based on these data may be beneficial for guiding antimicrobial treatment and earlier therapy.

Reduction in length of hospitalisation for microbial keratitis patients

Prolonged hospital stay in the course of management of microbial keratitis patients has been a burden to the resources of a multi-disciplinary tertiary hospital. The paper aims to evaluate the impact of streamlining the workflow and increased cross-disciplinary interactions on the average length of hospitalisation. It also seeks to study secondary outcomes including the average time for initiation of therapy, microbial culture positive rate, patients' satisfaction and resource savings. The authors employed the model of clinical practice improvement (CPI) (New South Wales Health Department) methodology for a systematic approach to improve processes of care and service delivery. A team consisting of ophthalmologist, microbiologist, pharmacist and nursing staff was formed to brainstorm and highlight the problems. A new workflow was formulated and data were prospectively collected to evaluate and to identify areas where improvements could be made. The average length of hospitalisation stay was reduced from 7.43 to 5.93 days with a mean difference of 1.50 +/- 0.63 days (p < 0.05). The microbial keratitis culture positive rate increased from 54.6 to 73.0 per cent (p > 0.05). The average time taken to initiate antibiotic eye drops after first contact with the doctor was 26.1 minutes (n = 28), and 74.4 per cent of the patients surveyed were satisfied with their length of stay. Intervention was carried out on the top 20 per cent of areas for improvement after voting by the team members. The reduction in average length of hospitalisation can be improved by strict adherence to a formulated workflow and coordinated cross-disciplinary interactions. The management protocol discussed in the paper for microbial keratitis enables more effective and efficient treatment for the inpatients. Increased cross-discipline and nursing coordination decreases length of hospitalisation of microbial keratitis patients and achieve better care for these patients.

Microbiological and clinical profiles of patients with microbial keratitis residing in nursing homes

Aim:To study the microbiological and clinical profile of patients with microbial keratitis living in nursing homes.Methods:A retrospective analysis of hospital records from 1996 to 2006 of patients who had microbial...

Microbial Keratitis in Patients With Down Syndrome: A Retrospective Study

To study the microbiological and clinical profile of cases of microbial keratitis in patients with Down syndrome. A retrospective chart review of all patients with Down syndrome and microbial keratitis admitted to the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, between January 1997 and January 2007 was undertaken. Main parameters evaluated were clinical and microbiological profile and final outcome. Of 18 patients included in this study, 11 were men and 7 were women, with mean age of 50 +/- 29 years (range 20-61 years). The most common associated ocular abnormality was eyelid diseases (94%) followed by atopic keratoconjunctivitis (44%). Positive microbiological cultures were obtained in 5 (28%) cases with Streptococcus pneumoniae being the most prevalent isolate. Ocular herpes was detected in 2 patients with polymerase chain reaction. Surgical intervention was required in 13 (72%) patients in the form of keratoplasty (n = 3) corneal gluing (n = 2), tarsorrhaphy (n = 5), botox injection (n = 1), and enucleation (n = 2). Microbial keratitis in Down syndrome is associated with eyelid problems and ocular atopy, and due to failure of medical therapy alone, surgical intervention is required in majority of cases.

Microbial keratitis in a case of lamellar ichthyosis

We report a case of microbial keratitis in a patient with lamellar ichthyosis. An 11-year-old boy, a known case of lamellar ichthyosis, presented with microbial keratitis. Microbiological evaluation of corneal scraping revealed a mixed infection caused by gram-negative bacilli and gram-positive cocci. He was treated with topical ciprofloxacin and fortified cefazolin eyedrops. Microbial keratitis in patients with lamellar ichthyosis has a poor prognosis.

Impact of prior therapy on the recovery and frequency of corneal pathogens.

To document the impact of prior antibiotic therapy on the recovery of corneal pathogens. Medical records and laboratory reports of 334 consecutive microbial keratitis patients examined from January to December 2000 were reviewed. Comparisons of pathogens, culture positive rate, recovery time, antibiotic sensitivity profile, delay in presentation, and final visual acuity were analyzed for patients treated before presentation and those who were not. The chi square test was used to determine statistical significance. Of the 334 patients, 56% were exposed to at least one course of topical antimicrobials before culture. Patients on therapy were only slightly more likely to be culture negative (P = 0.317) but significantly more likely to have a delay in pathogen recovery (P = 0.002). Patients given prior antibiotics took significantly longer to heal (P = 0.003). Gram-negative organisms (47.5%) were the most frequent pathogens isolated from all culture-positive patients, followed by gram positives (28.7%), fungi (15.8%), and parasites (2%). An increase and significant difference in the frequency of fungi (P = 0.000) and acanthamoeba was reserved for the pretreated group. Gram negative organisms were more often isolated from patients who had not been pretreated (P = 0.002). Pretreated patients were more like to have a pathogen resistant to 1 or more of the commonly prescribed ocular antibiotics (P = 0.02). There is a delay in starting microbiologic-guided antibiotic treatment in patients who have received empiric therapy. Nonbacterial corneal pathogens may be associated more frequently with patients on prior therapy.

Corneal ulceration in the elderly in Hyderabad, south India

AIMSTo report demographic, microbiological, therapeutic, anatomical, and visual results of corneal ulceration in the elderly patients seen at a tertiary eye care centre in south India.METHODS102 consecutive cases of microbial...

Microbial Contamination of In-Use Ocular Medications

Two hundred twenty in-use medications from 101 patients with nonmicrobial ocular surface disease were studied by culturing the bottle caps, a drop produced by simple inversion, and the interior contents removed sterilely. Conjunctival cultures were taken from these patients and 50 age-matched controls. Pathogenic organisms were harvested from conjunctivae significantly more frequently (P less than .01) from cases (34 of 101) than from controls (five of 50). Sixty-four medications (29%) had microorganisms cultured from at least one medication site. Gram-negative organisms were significantly more likely (P less than .00001) to be isolated from all medication sites than gram-positive organisms. Additionally, when isolated from medication sites, the gram-negative organisms were highly likely to be cultured from the conjunctiva as well. This was not true for pathogenic gram-positive organisms. We conclude that a cycle of contamination between in-use medications and conjunctivae may represent an important risk factor for microbial keratitis in patients with ocular surface disease.