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Roger W Beuerman, A. Mishra, AL Tan, MH Periayah, X Lian, R Sultana, SE Saffari, WB Khor, Jodhbir Mehta, Donald Tan; Asia Cornea Society Infectious Keratitis Study: Pseudomonas aeruginosa infectious keratitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):854.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: P. aeruginosais one of the leading pathogens associated with ocular infections. It is notorious because it is becoming difficult to treat due to antibiotic resistance.In the present study, antibiotic susceptibility profiles of P. aeruginosaisolated from infectious keratitis patients were tested. Antibiotics used for treatment and clinical outcomes were also compared.This prospective observational study was conducted over 12-18 months at thirteen study centers in China, India, Japan, South Korea, Taiwan, Philippines, Thailand and Singapore.
Methods: P. aeruginosa(n=222) were confirmed using MALDI-TOF at the Diagnostic Bacteriology Laboratory, Singapore General Hospital. Antibiotic susceptibilities were tested using customized panels from SensititreR, at Microbiology laboratory, Singapore Eye Research Institute. Susceptibility data was interpreted according to CLSI guidelines. Trial was registered as NCT01560208; all sites obtained local ethics approval.
Results: P. aeruginosakeratitis was observed equally in males (49.5 %) and females (50.5 %) and was evenly distributed in all age groups. Contact lens wear was the commonest risk factor (55.0 %) followed by trauma (22. 2%). Infection completely resolved with treatment in 71.6 % patients. Infection was not resolved and acute surgical intervention was required in 7.2 % cases. In 1.8 % cases infection resolved but acute intervention was still required. Almost 18.5 % patients were lost to follow up. Susceptibility varied against different antibiotics – amikacin (99. 1 %), cefepime (98.6 %), ciprofloxacin (98.2), gentamicin (97.3 %), gatifloxacin (95.3 %), besifloxacin (91.4 %), moxifloxacin (89.5 %), piperacillin/ tazobactam (93.7 %), polymyxin B (95.9 %), tobramycin (97.3 %) and imipenem (20.7 %). Only five (2.2 %) isolates were resistant against all tested fluoroquinolones.Cefazolin, moxifloxacin, amikacin levofloxacin, ciprofloxacin, and gentamicin were prescribed in 50.0%, 21.1 %, 9.0%, 3.1%, 2.7 % and 2.7 % patients respectively. Interestingly 95.5% of patients on cefazolin received gentamicin as second antibiotic. Overall, 25.25 % and 2.25 % patients received a third and fourth antibiotic.
Conclusion: P. aeruginosaisolates were fairly susceptible against tested antibiotics. However, clinical outcomes in 9.0% of patients were still serious requiring surgical interventions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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