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Paediatric infectious keratitis: a case series of 107 children presenting to a tertiary referral centre
  1. Julia Dutra Rossetto1,2,
  2. Kara M Cavuoto1,
  3. Carla J Osigian1,
  4. Ta Chen (Peter) Chang1,
  5. Darlene Miller1,
  6. Hilda Capo1,
  7. Oriel Spierer1,3
  1. 1 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo, Sao Paulo, Brazil
  3. 3 Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Oriel Spierer, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, Florida, 33136, USA; spierero{at}gmail.com

Abstract

Background/aims Corneal ulcers can result in severe visual impairment in children. The recent trends of paediatric microbial ulcerative keratitis in the USA are unknown. The purpose of this study is to report the risk factors, microbiological profile and treatment outcomes of paediatric microbial keratitis in South Florida.

Methods A university-based tertiary eye care centre retrospective case series between 1992 and 2015. Medical records of 107 paediatric patients (age <18 years) with the diagnosis of microbial ulcerative keratitis were analysed. Patient demographics, culture data, microbial susceptibility, management trends and patient outcomes were collected.

Results Mean age of patients was 13±4.6 years (range 0.2–17 years). The most common associated risk factor was contact lens wear (77.6%), followed by ocular trauma (8.4%). Systemic factors were present in 4.7% of cases. Cultures were taken from 89 patients. A total of 74 organisms were isolated from the 52 corneal scrapings with growth, yielding a 58.4% positivity rate. Seventeen microbial species were identified, with a predominance of Pseudomonas aeruginosa (46.2%), followed by Stenotrophomonas maltophilia (19.2%) and Fusarium (13.5%). Combined fortified antibiotics were the most common treatment (51.4%). Mean follow-up time was 40.6±91.6 weeks (range: 0.3–480 weeks). The mean visual acuity improved from 20/160 to 20/50 (p<0.0001). No therapeutic penetrating keratoplasty was needed.

Conclusions In this study, contact lens wear was the most frequent risk factor in infectious keratitis in children. P. aeruginosa was the most common microorganism present in our setting. The majority of the cases responded well to medical management.

  • Cornea
  • Infection
  • Microbiology
  • Contact lens
  • Child health (paediatrics)

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Footnotes

  • Contributors Design and conduct of the study: JDR, KMC, CJO, TCC, DM, HC, OS; collection: JDR, KMC, CJO, OS, management: KMC, TCC, DM, HC, analysis and interpretation of the data: JDR, KMC, CJO, TCC, DM, HC, OS; preparation: JDR, KMC, CJO, OS, review: TCC, DM, HC and approval: JDR, KMC, CJO, TCC, DM, HC, OS of the manuscript.

  • Funding JDR: funded by CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil. KMC, TCC, DM and HC: supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant.

  • Competing interests None declared.

  • Ethics approval Institutional Review Board of the University of Miami Miller School of Medicine.

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

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