Abstract
Purpose :
To identify demographic characteristics, causative microbes, resistance patterns and complications of microbial keratitis cases over 5 years in a Western Sydney Hospital.
Methods :
Retrospective review over 5 years (2012-2017) of consecutive microbial keratitis cases at Westmead Hospital. All patients who were coded with microbial keratitis related events were identified and had their files reviewed. We included all cases with a diagnostic corneal culture (scrape or biopsy) through pathology data from the NSW Health Pathology Network. Demographics, ocular history, isolated microbes, antimicrobial sensitivity, and clinical outcomes were collated from medical records. Positive growth of a microbe and antimicrobial resistance was determined in accordance with the clinical breakpoint criteria used by the hospital laboratory in accordance with NSW pathology guidelines.
Results :
80 cases of microbial keratitis of 72 patients were included over the 5 year period. The mean age was 57.3 years (range 18 to 95), 52.5% male. 41% patients presented directly to emergency departments, 36% were referred by ophthalmologists, 21% by family doctors and 1% by optometrists. 90% (n = 72/80) were treated as inpatients, with a median length of hospital admission of 5 days (IQR= 3-7). 21% (n = 15/72) of patients were contact lens wearers. 71% (n=57/80) of isolates were bacterial, 19% (n=12/80) viral, 6% (n=5/80) fungal and 1% (n=1/80) acanthamoeba. Pseudomonas aeruginosa was the most commonly cultured organism (n=16, 20%), followed by Staphylococcus aureus with (n=8) 10%, and Staphylococcus epidermidis 7.5% (n=6/80). 13% of Pseudomonas aeruginosa isolates (2 of 16) were resistant to ciprofloxacin. There were no cases of resistance to tobramycin or gentamicin. The epithelial defect healed in 64% (51/80) of eyes with a median time of 21 days (range 1- 170 days). Surgical intervention for anatomical or sight preservation was required in 12.5% (n=10/80) of cases. The most common complication was corneal perforation in 17.5% of cases (n=80).
Conclusions :
Pseudomonas aeruginosa was the mostly commonly isolated organism with low resistance to ciprofloxacin. The most common risk factor for microbial keratitis was contact lens wear and the, most common complication was corneal perforation. Two-thirds of patient’s epithelial defects healed within 3 weeks.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.