Abstract
Purpose :
To provide an up-to-date clinical characterization of Serratia marcescens keratitis and to assess changes in the microbiological spectrum and clinical trends of the infection over time.
Methods :
Forty-six culture-proven cases (46 eyes) of Serratia marcescens ocular infection diagnosed and treated at the University of Pittsburgh Eye Center between Feb 2002-Feb 2020 were included in this retrospective, observational case series and reviewed for clinical and microbiological characteristics. Data collected from patient records included demographics, ocular and systemic risk factors, follow-up length, initial and final visual acuity, symptom duration prior to presentation, infiltrate size and shape, medical management, adjunctive management, time to defect closure, duration of treatment, microbiological characteristics, and antibiotic susceptibilities.
Results :
Mean presenting age was 46.8 years with mean follow-up time of 329 days. Prevalent ocular comorbidities were contact lens use (68.6%), history of corneal disease (52.9%), lid pathology (25.5%), and glaucoma (15.7%). Systemic comorbidities were present in 58.8% of patients, with systemic atopy (49.0%) and immunosuppression (37.3%) being most common. Average treatment duration was 152 days, with most common administration of fluoroquinolones (76.5%) and fortified antibiotics (60.8%). Visual outcomes generally improved with treatment, with an average initial visual acuity (VA) of 1.3 logMar and final VA of 0.86 logMar. Worse final VA was associated with glaucoma (p=0.038), hypopyon (p=0.045), older age (0.000), worse initial VA (p=0.009), longer time to defect closure (p=0.020), and larger infiltrate (p=0.037). All cases showed antibiotic sensitivity to ciprofloxacin (100%), and most showed resistance to cefazolin (80.4%). No significant changes in clinical profile or treatment were observed over the 18-year period.
Conclusions :
S. marcescens keratitis is associated with contact lens use and poor ocular surface. Fluoroquinolones and fortified antibiotics have shown effective management and improved visual outcomes. Worse outcomes are associated with older age and worse severity at presentation. Microbiological and clinical trends of this ocular infection have remained constant over nearly 20 years.
This is a 2021 ARVO Annual Meeting abstract.