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KMID : 0360220210620040447
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Journal of the Korean Ophthalmological Society
2021 Volume.62 No. 4 p.447 ~ p.462
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Clinical Features and Antibiotic Susceptibility of Culture-proven Infectious Keratitis: a Multicenter 10-year Study
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You In-Cheon
Lee Sang-Bumm
Seo Kyoung-Yul
Kim Mee-Kum
Yoon Kyung-Chul
Koh Jae-Woong
Lee Ji-Eun
Kim Seong-Jae
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Abstract
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Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period.
Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 andDecember 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms,therapeutic outcomes, and prognosis.
Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species.
Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) andevisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible tomoxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. Anincrease in resistance to these antibiotics was detected for Enterococcus and Pseudomonas.
Conclusions: In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonasaeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medicaland surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimizeinfection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon,age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years ormore was a significant risk factor for poor clinical outcome of fungal keratitis.
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KEYWORD
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Fusarium, Keratitis, Microbial sensitivity tests, Pseudomonas aeruginosa, Staphylococcus epidermidis
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