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Clinical science
Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital
  1. Haoxing Jin1,
  2. Walter T Parker2,
  3. Nathan W Law1,
  4. Cameron L Clarke1,
  5. Jordan D Gisseman1,
  6. Stephen C Pflugfelder2,
  7. Li Wang2,
  8. Zaina N Al-Mohtaseb2
  1. 1Department of Ophthalmology, School of Medicine, Baylor College of Medicine, Houston, Texas, USA
  2. 2Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr. Zaina N Al-Mohtaseb, Cullen Eye Institute, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030, USA; zaina{at}bcm.edu

Abstract

Purpose: To identify the risk factors, causative organisms, antimicrobial susceptibility and outcomes of microbial keratitis in a large county hospital in Houston, Texas.

Design: Case series.

Methods Setting: A large county hospital in Houston, Texas.

Study Population: Patients with known diagnosis of microbial keratitis from January 2011 to May 2015.

Observation Procedure: Retrospective chart review.

Main Outcomes: Epidemiology, risk factors, outcomes and antibiotic susceptibility of microbial keratitis.

Results The most commonly identified risk factors were contact lens use (34.4%), ocular trauma (26.3%), diabetes mellitus (16.7%), ocular surgery (13.5%), ocular surface diseases (11.5%), previous keratitis (10.4%), glaucoma (6.3%), cocaine use (5.2%) and HIV-positive status (4.2%). Eyes with positive cultures (61.5%) were associated with worse visual outcomes (p=0.019) and a higher number of follow-up visits (p=0.007) than eyes with negative cultures (38.5%). Corneal perforation was the most common complication (11.5%). Gram-negative organisms (21.9%) were all susceptible to ceftazidime, tobramycin and fluoroquinolones. Gram-positive organisms (33.3%) had worse outcomes than Gram-negative organisms (21.9%) and exhibited a wide spectrum of antibiotic resistance, but all were susceptible to vancomycin. Twenty-seven per cent of the coagulase-negative Staphylococci were resistant to fluoroquinolones.

Conclusion This study identified a recent shift in risk factors and antibiotic resistance patterns in microbial keratitis at a County Hospital in Houston, Texas. In our patient population, fluoroquinolone monotherapy is not recommended for severe corneal ulcers. On the basis of these results, vancomycin and tobramycin should be used for empirical therapy until microbial identity and sensitivity results are available.

  • Cornea
  • Infection
  • Microbiology
  • Epidemiology

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Footnotes

  • Contributors HJ, WTP and ZNA have contributed substantially to the conception, design, data acquisition, analysis, interpretation, drafting, revising and final approval of the work.

    NWL, CLC and JDG have contributed substantially to the data acquisition, revising and final approval of the work.

    SCP has contributed substantially to the conception, design, revising and final approval of the work.

    LW has contributed substantially to the conception, design, data analysis and interpretation, revising, and final approval of the work.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SCP is a consultant for Allergan and Shire. ZNA is a consultant for Bausch and Lomb. For the remaining authors none were declared.

  • Patient consent This was a retrospective chart review study and therefore did not require signed patient consents.

  • Ethics approval Institutional Review Board at Baylor College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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