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. 2019 Feb:198:54-62.
doi: 10.1016/j.ajo.2018.09.032. Epub 2018 Oct 9.

Laboratory Results, Epidemiologic Features, and Outcome Analyses of Microbial Keratitis: A 15-Year Review From St. Louis

Hugo Y Hsu  1 , Benjamin Ernst  2 , Eric J Schmidt  2 , Rohit Parihar  2 , Chelsea Horwood  2 , Sean L Edelstein  2
Affiliations

Laboratory Results, Epidemiologic Features, and Outcome Analyses of Microbial Keratitis: A 15-Year Review From St. Louis

Hugo Y Hsu et al. Am J Ophthalmol. 2019 Feb.

Abstract

Purpose: To evaluate the laboratory results and prognostic factors of poor clinical outcomes in microbial keratitis cases over 15 years at Saint Louis University.

Design: Retrospective cohort and trend study.

Methods: Microbiological and clinical information from culture-positive cases seen at Saint Louis University from 1999 to 2013 were reviewed retrospectively. Statistical analyses were used to determine microbiological and antibiotic susceptibility trends. Prognostic factors of poor clinical outcome from the literature were used to create multivariate regression models to describe our cohort.

Results: Gram-positive organisms predominated (48%), followed by gram-negative organisms (34%) and fungi (16%). The most commonly isolated organism was Pseudomonas aeruginosa (21%). Oxacillin-resistant rates of Staphylococcus aureus and coagulase-negative staphylococci were 45% and 43%, respectively. Only the proportion of Pseudomonas changed significantly over time (P = .02). The only antibiotic found to lose efficacy over time was gentamicin for gram-positive organisms (P = .005). Multivariate logistic regression analyses revealed that major complications were associated with large ulcers (P < .006), fungal cases (P < .001), and comorbid ophthalmic conditions (P < .001). Poor healing was associated with large ulcers (P < .001) and fungal cases (P < .001). Lastly, poor visual outcome was associated with large ulcers (P < .01) and age ≥ 60 years (P < .02).

Conclusions: In the St Louis area, oxacillin-resistant organisms, Pseudomonas aeruginosa, and fungi are commonly recovered from microbial keratitis cases with a disproportionally high incidence. Hence, empiric antibiotic choice should reflect these trends. Special care needs to be taken for patients with large ulcers and fungal infections, as well as elderly patients with comorbid ophthalmic conditions, as these patients have worse clinical outcomes.

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References

    1. Jeng BH, Gritz DC, Kumar AB, et al. Epidemiology of ulcerative keratitis in Northern California. Arch Ophthalmol 2010; 128(8):1022–1028. - PubMed
    1. Collier SA, Gronostaj MP, MacGurn AK, et al. Estimated burden of keratitis—United States, 2010. MMWR Morb Mortal Wkly Rep 2014; 63(45):1027–1030. - PMC - PubMed
    1. McDonnell PJ, Nobe J, Gauderman WJ, Lee P, Aiello A, and Trousdale M. Community care of corneal ulcers. Am J Ophthalmol 1992; 114(5):531–8. - PubMed
    1. Hsu HY, Nacke R, Song JC, Yoo SH, Alfonso EC, and Israel HA. Community opinions in the management of corneal ulcers and ophthalmic antibiotics: A survey of 4 states. Eye Contact Lens 2010; 36(4):195–200. - PubMed
    1. Asbell PA, Sanfilippo CM, Pillar CM, DeCory HH, Sahm DF, and Morris TW. Antibiotic resistance among ocular pathogens in the United States: Five-year results from the antibiotic resistance monitoring in ocular microorganisms (ARMOR) surveillance study. JAMA Ophthalmol 2015; 133(12):1445–54. - PubMed

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