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Namita Bhardwaj, Pulin Shah; Epidemiology, risk factors, and microbiological profiles of infectious corneal ulcers in Southeastern Louisiana. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5457.
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To describe the epidemiology, risk factors, and microbiology of patients with infectious corneal ulcers treated at an urban tertiary eye care referral center in New Orleans, Louisiana.
We conducted a retrospective chart review of all patients treated for infectious corneal ulcers at Ochsner Medical Center in New Orleans, Louisiana between January 1, 2011-October 31, 2013. These cases were identified by searching for patients historically designated the following ICD-9 codes: corneal ulcer unspecified (370.00), ring corneal ulcer (370.02), central corneal ulcer (370.03), hypopyon ulcer (370.04), mycotic corneal ulcer (370.05), and perforated corneal ulcer (370.06). Primary outcome measures included: patient demographics, predisposing risk factors, microbiology of corneal scrapings, antibiotic choice, and the need for surgery.
The charts of 247 patients (56.3% female, mean age 45.4 ± 20.1 years) were reviewed. The most common risk factor identified was contact lens wear in 150 (60.7%) patients followed by organic foreign body in 16 (6.5%) patients. 34 (13.8%) patients were pseudophakic and 34 (13.8%) patients had other prior surgery in the affected eye, of which penetrating keratoplasty in 14 (41.2%) was the most common. Medical treatment was initiated in all patients and 31 (12.6%) patients also underwent surgical intervention. Of the surgical procedures performed, 18 (58.1%) patients underwent total penetrating keratoplasty. Of the 143 (57.9%) patients who underwent corneal scraping, 70 (49.0%) demonstrated a positive culture yield. The most common organism isolated was Pseudomonas aeruginosa in 20/70 (28.6%), followed by Staphylococcus aureus 13/70 (18.6%) of which Methicillin-resistant Staphylococcus aureus predominated in 9/13 (69.2%). 16/70 (22.9%) patients had positive fungal cultures where Curvularia was the most common organism isolated in 8/16 (50%). The most commonly prescribed class of antibiotic was fluoroquinolone in 208 (84.2%) patients. 90 (36.4%) patients were treated with fortified antibiotics. Among the 42/70 (60.0%) patients with positive bacterial cultures, 6 (14.3%) were resistant to fluoroquinolones, and 9 (21.4%) were resistant to 3 or more classes of antibiotic.
This study outlines the features characteristic to this particular patient population to guide further care of patients diagnosed with infectious corneal ulcers.
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