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D. Girgis, C. Karp, D. Miller; Update on Clinical Outcomes of Ocular Infections due to Nontuberculous Mycobacteria. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5949.
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To identify the microbiological profile, clinical features, and treatment response of cases of ocular infection due to species of nontuberculous mycobacteria (NTM).
Charts of patients seen at the Bascom Palmer Eye Institute with a diagnosis of culture positive atypical mycobacterial ocular infections from January 1980 to July 2007 were retrospectively reviewed.
Of the charts reviewed, a total of 142 eyes involving 139 patients, including 3 patients with bilateral infection, were identified with an ocular infection due to NTM. A total of 183 isolates were collected from these patients. Of the 183 isolates, 91.1% (166/183) were detected on microbiologic media within 10 days. Approximately 61% (83/136) of infections were initially diagnosed within 4 weeks of presentation, and 63.1% (89/141) of ocular infections with NTM were associated with the presence of biomaterials. The most common diagnoses included keratitis 27.5% (39/142), keratitis after LASIK 9.2% (13/142), scleral buckle infection 14.8% (21/142), and socket/implant infection 14.8% (21/142). At least two antibiotics were used to treat 80.3% (109/136) of infected eyes. Overall, 81.3% (143/176) of isolates were sensitive to amikacin, 93.2% (150/161) sensitive to clarithromycin, 30.9% (21/68) sensitive to gatifloxacin, 21.4% (15/70) sensitive to moxifloxacin, 10.3% (16/155) sensitive to ciprofloxacin, and 36.4% (24/66) sensitive to linezolid. Surgical interventions in order to achieve resolution of disease were necessary in 69% (93/134) of infected eyes. Approximately 55.5% (65/117) of infected eyes required five to twelve weeks of antibiotic therapy. Only 9.3% (11/118) of infections resolved within four weeks from the time of diagnosis, and 70.3% (83/118) of infections resolved within 5 to 24 weeks.
The incidence of ocular infections due to NTM has been increasing in recent years, with a significant number of infections associated with the presence of biomaterials. Ocular infections due to NTM often require prolonged treatment with more than one drug. Fluoroquinolones provide inadequate coverage for these microorganisms. In addition, surgical interventions are often warranted for infections refractory to treatment with drugs alone.
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