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David Truong, H Dwight Cavanagh; Microbial Keratitis in North Texas: Public and Private Patient Populations. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2345.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the epidemiology, risk factors, microbiologic spectrum, and treatment of microbial keratitis at an urban public hospital to an adjacent private practice with the same physicians.
Retrospective chart review in the 5-year interval 2009 through 2014. Primary outcome measures included best-corrected visual acuity (BCVA), risk factors, culture and sensitivities, treatment, and complication rates.
331 eyes with microbial keratitis have been identified. Contact lens wear, ocular trauma, and ocular surface diseases were the most common risk factors. Gram-positive organisms represented 46%, gram-negative organisms 39%, fungal organisms 15%, and Acanthamoeba <1% of corneal isolates. No common corneal pathogens were resistant to aminoglycosides or vancomycin. 48% of cases were initially treated with fortified antibiotics, 43% with fluoroquinolone monotherapy, and 6% with antifungals. At resolution, average BCVA was 20/82 [logMAR 0.61] with 8% of cases resulting in light perception or worse vision. The perforation rate was 8%. 6% of cases underwent urgent penetrating keratoplasty and 4% of cases underwent urgent enucleation or evisceration. The public hospital population was (1) younger, (2) more likely to have used contact lenses, (3) more likely to be admitted for inpatient treatment, (4) more likely to be treated with combination fortified antibiotics, and (5) less likely to harbor antibiotic-resistant pathogens. The complication rates were similar between the two populations.
Microbial keratitis remains a clinical challenge in the urban public hospital setting and may represent a distinct entity requiring a tailored approach.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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