Clinical and Microbiological Profile of infectious Keratitis in Children

Abstract

 

Purpose

 

To describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children.

 

Methods

 

Retrospective and descriptive study of pediatric patients with diagnosis of infectious keratitis attended at Ophthalmology Institute between January 2006 and December 2011. Demographics, predisposing factors and clinical signs were recorded.

 

Results

 

41 eyes of 41 patients with infectious keratitis. Fifty-one percent were males. Mean age was 8.73 years + 5.14. Time between the onset of symptoms and ophthalmological examination was 12.7 days + 18.71. Seventy eight percent showed predisposing factors; ocular trauma was the most common (25%). Mean visual acuity at discharge logMAR 0.76 + 0.64 (20/115) was significantly better than mean visual acuity at admission logMAR 1.49 + 1.15 (20/618), p < 0.05. Visual axis involvement was registered in 63.2%, anterior chamber reaction in 31.6% and hypopyon in 15.8%. Positivity of cultures was 34.1%. The most commonly isolated microorganisms were gram-positive cocci (27%); Staphylococcus epidermidis (10%) was the most common gram-positive microorganism found. Two strains of Pseudomonas aeruginosa were also isolated. Staphylococcus sp. isolates were sensitive to gentamicin, vancomycin and ciprofloxacin and resistant to sulfamethoxazole. Multiple antibiotic resistances were found in almost all Staphylococcus sp. isolates. The two strains of Pseudomonas aeruginosa were sensitive to gentamicin and resistant to ciprofloxacin and ceftazidime.

 

Conclusions

 

In children, ocular trauma is the principal predisposing factor for infectious keratitis. Responsible factors for visual impairment may be visual axis involvement, delay in ophthalmological care, inadequate adherence to treatment and low positivity of cultures. The most common microorganism, Staphylococcus sp., showed multiple-antibiotic resistance in the majority of cases. Pseudomonas aeruginosa isolates were resistant to ceftazidime, considered as first line drug in gram-negative keratitis. Apparent resurgence of susceptibility to gentamicin was observed.

 

Keywords: 573 keratitis • 463 clinical (human) or epidemiologic studies: prevalence/incidence • 464 clinical (human) or epidemiologic studies: risk factor assessment