Abstract
Purpose :
To analyze the demographics, predisposing factors, clinical manifestation, pathogen, treatment of microbial keratitis(MK) in a regional teaching facility in northern Taiwan. We included hospitalized and non-hospitalized patients in this study, in order to represent the real-world data of community.
Methods :
This retrospective study included patients clinically diagnosed with microbial keratitis at the Taipei Tzu Chi Hospital from January 2017 to December 2020. Demographics, predisposing factors, clinical manifestations, culture results, and treatments used were collected from medical records and analyzed.
Results :
Microbial keratitis was diagnosed in 75 patients (37 male and 38 female; mean age, 50.23 years). 23 cases (30.7%) were referred from local private clinics. 65 cases (86.7%) were treated without hospitalization while 10 cases (13.3%) were hospitalized. Potential predisposing factors, which were usually multiple, are analyzed. The main predisposing risk factor was soft contact lens wearing (28.0%). The secondary risk factor was eye trauma (22.6%). Conjunctival injection was found in all patients and was the most common clinical manifestation of microbial keratitis. Cultures was done on 52 eyes, with positive results in 23 eyes(culture positive rate 44.2%). Commonly identified pathogens included pseudomonas species (21.7%) , followed by staphylococci species (17.3%). For the choice of primary antibiotics, commercial antibiotics such as Cravit and Gentamicin were used in about 60% of the cases, while fortified antibiotics were used in 40% of the cases. 68 cases (90.7%) were successfully treated with medical treatment, and 7 cases (9.3%) required surgical intervention such as perforation repair or even evisceration. After adjustment with multivariate analysis, the depth of stromal infiltration was the best guide to initiate fortified antibiotics instead of commercial agents.
Conclusions :
Contact lens wear remained the most common risk factor. Pseudomonas species was the most commonly identified pathogen. Our culture positive rate is comparable to tertiary centers even when our corneal lesion presentation is early and less aggressive. The deep stromal infiltration should be a guide to initiate fortified topical antibiotics Through this real-world data of regional community, we hope can provide early clues for effective management of microbial keratitis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.