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Grant Carlisle, Olivia Waldron, Ingrid U Scott, Seth Pantanelli, Gargi Vora, Michael C Chen; Impact of Corneal Culture Results on Management of Suspected Microbial Keratitis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3469.
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To investigate the impact of corneal culture results on the management of patients treated for suspected microbial keratitis at a tertiary-care academic institution.
The Penn State College of Medicine Institutional Review Board reviewed the study protocol and determined the study was exempt from further review. Medical records were reviewed of patients who underwent corneal culture (CPT code 65430) at Penn State Eye Center between 01/01/2015 and 09/01/2020.
A total of 59 corneal cultures from 54 patients were reviewed. The overall culture positivity rate was 46%. Forty-four percent of the positive cultures and 69% of the negative cultures were obtained from eyes treated with topical antibiotics prior to the culture being taken. Bacteria were isolated most commonly (82%), followed by fungi (11%), and Acanthamoeba (7%). The most common bacteria isolated were Staphylococcus aureus (33%), Staphylococcus epidermidis (25%), coagulase negative Staphylococcus (12%), and Pseudomonas aeruginosa (8%). Fungal species isolated included Candida albicans, Candida parapsilosis, Gorodonia species and Fusarium species with equal prevalence. Of the Staphylococcus species isolated, one was resistant to moxifloxacin (S. aureus) and seven were resistant to oxacillin (S. aureus and S. epidermidis). Initial therapy included fortified vancomycin and tobramycin in 61% of eyes and moxifloxacin in 22 % of eyes. Culture results resulted in a management change in 38% of eyes: In 10% of eyes, treatment was escalated, defined as adding or changing to fortified antibiotics, antifungal or anti-acanthamoeba agents, and in 28% of eyes, treatment was de-escalated, defined as discontinuing either vancomycin or tobramycin or changing from fortified antibiotics to commercially available fluoroquinolones.
Culturing corneas with suspected microbial keratitis can impact management in a significant proportion of cases.
This is a 2021 ARVO Annual Meeting abstract.
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