Bacterial keratitis in the critically ill
a Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1
2LX, b Public Health Laboratory,
Bristol Royal Infirmary, Bristol BS2 8HW, c Directorate of Pathology (Microbiology), University of
Bristol, Bristol Royal Infirmary, Bristol BS2 8HW
Correspondence to: Stuart Cook.
Accepted for publication 13 August 1997
BACKGROUND
In the 4 year period (1988-91) there
were nine cases of bacterial keratitis in five critically ill patients
on an intensive care unit (`unit A'), all except one due to
Pseudomonas aeruginosa. Many of these patients had serious
ocular complications requiring surgery and all surviving patients were
left with significant visual deficits. One further case of keratitis
due to P aeruginosa occurred on unit A in April 1993. The
problem of keratitis in ventilated patients is not unique to this unit
as a further four cases in three patients from additional units in this
area have been treated.
METHODSPredisposing factors in unit A were
established through subsequent investigations. It was found, in
particular, that all the ocular infections were preceded by
colonisation of the respiratory tract with the pathogenic organism.
Recommendations concerning eye care and tracheal suctioning were
adopted by unit A in 1991.
RESULTSIn the subsequent 4 years (1991-5), the
frequency of isolation of pseudomonas from the respiratory tract per
patient treated in unit A remained relatively high at 3.8% (153/4032).
However, the conjunctival pseudomonas isolation rate has decreased
significantly (p <0.001) from 0.8% (19/2430) to 0.05% (2/4032).
CONCLUSIONSVentilated patients may be at risk
from inoculation of pathogens into the eyes. The principal risk factor
for bacterial keratitis in this series was corneal exposure secondary
to conjunctival chemosis or lid damage. The adoption of simple
preventative measures on unit A had a significant impact on the
incidence of eye infections due to pseudomonas, despite the high
proportion of patients whose respiratory tracts were colonised with the
same organism. There is a need for additional research into the most
effective method of eye care for ventilated patients in order to reduce
the frequency of this avoidable condition.
© 1997 by British Journal of Ophthalmology
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Ezra, D G, Lewis, G, Healy, M, Coombes, A
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