Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;105(3):328-333.
doi: 10.1136/bjophthalmol-2020-316128. Epub 2020 Jun 24.

12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study

Darren Shu Jeng Ting  1 , Charlotte Shan Ho  2 , Jessica Cairns  2 , Ahmad Elsahn  1 , Mouhamed Al-Aqaba  1 , Tim Boswell  3 , Dalia G Said  1   4 , Harminder Singh Dua  5
Affiliations

12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study

Darren Shu Jeng Ting et al. Br J Ophthalmol. 2021 Mar.

Abstract

Background/aims: To examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK.

Methods: A retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed.

Results: The estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22).

Conclusion: IK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.

Keywords: cornea; epidemiology; infection; microbiology; ocular surface.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The pattern of incidence of infectious keratitis in the region of Nottingham, UK, between 2007 and 2019. IK, infectious keratitis.
See this image and copyright information in PMC

References

    1. Ung L, Bispo PJM, Shanbhag SS, et al. . The persistent dilemma of microbial keratitis: global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 2019;64:255–71. 10.1016/j.survophthal.2018.12.003 - DOI - PMC - PubMed
    1. Austin A, Lietman T, Rose-Nussbaumer J. Update on the management of infectious keratitis. Ophthalmology 2017;124:1678–89. 10.1016/j.ophtha.2017.05.012 - DOI - PMC - PubMed
    1. McDonald EM, Ram FSF, Patel DV, et al. . Topical antibiotics for the management of bacterial keratitis: an evidence-based review of high quality randomised controlled trials. Br J Ophthalmol 2014;98:1470–7. 10.1136/bjophthalmol-2013-304660 - DOI - PubMed
    1. Mencucci R, Paladini I, Menchini U, et al. . Inhibition of viral replication in vitro by antiviral-treated amniotic membrane. Possible use of amniotic membrane as drug-delivering tool. Br J Ophthalmol 2011;95:28–31. 10.1136/bjo.2010.179556 - DOI - PubMed
    1. Gicquel J-J, Bejjani RA, Ellies P, et al. . Amniotic membrane transplantation in severe bacterial keratitis. Cornea 2007;26:27–33. 10.1097/ICO.0b013e31802b28df - DOI - PubMed

Publication types

Substances