Bacterial Keratitis Preferred Practice Pattern®

Lin, Amy; Rhee, Michelle K.; Akpek, Esen K.; Amescua, Guillermo; Farid, Marjan; Garcia-Ferrer, Francisco; Varu, Divya M; Musch, David C.; Dunn, Steven P.; Mah, Francis S.; Panel, External Disease

doi:10.1016/j.ophtha.2018.10.018

Cited by 162 publications

(182 citation statements)

References 217 publications

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“…A healthy corneal epithelium is a protective barrier against bacterial infections, with the exception of a few bacterial species such as Neisseria, Corynebacterium, Haemophilus, and Listeria species. 2 Infections usually occur as a result of conditions that disrupt this important barrier, which are outlined below: 2, 10 1. Exogenous local factors Identifying the above risk factors through medical history, examination, testing, and appropriate consultations and managing them correctly will not only make treatment possible but also help prevent recurrence.…”

Section: Risk Factorsmentioning

confidence: 99%

“…There is typically an epithelial defect, and anterior chamber reaction is also common. 2,10 Pain, rapid stromal thinning, and descemetocele should immediately suggest a Pseudomonas infection. Yellowgreen purulent discharge and ground-glass appearance and loss of transparency in the adjacent corneal stroma are other important clinical features suggesting Pseudomonas.…”

Section: The Challenge Of Diagnosismentioning

confidence: 99%

“…In the Preferred Practice Pattern report for bacterial keratitis issued by the American Academy of Ophthalmology (AAO) in 2018, smears and culture are specifically recommended in the following cases: 10 1. If the infiltrate is centrally located, with large and/or significant stromal involvement or melting 2.…”

Section: When Are Smears and Culture Necessary?mentioning

confidence: 99%

“…If infiltrates are multifocal In addition, smears and culture were also found to be helpful in cases with history of injury by plant-based materials or swimming/using a hot tub while wearing contact lenses. 10…”

Section: When Are Smears and Culture Necessary?mentioning

confidence: 99%

“…Local anesthetic options that do not contain preservatives should be preferred in order to increase the likelihood of growth in culture, and tetracaine should be avoided due to its antimicrobial effect. 10 The sample can be obtained under a biomicroscope or surgical microscope with a flame-sterilized spatula (Kimura), 25-gauge needle, or sterile blades. Scraping should begin slightly outside the border of the infectious focus and deepen in the infiltrate zone so as to reach the ulcer surface.…”

Section: Sample Collection For Smears and Culturementioning

confidence: 99%

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<p>Treatment-Resistant Bacterial Keratitis: Challenges and Solutions</p>

Eğrilmez¹,

Yildirim-Theveny²

2020

OPTH

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Bacterial keratitis is an important ophthalmic emergency and one of the most common causes of corneal blindness. The main causes of treatment resistance in bacterial keratitis are failure to eliminate predisposing factors, misdiagnosis and mistreatment. At first, exogenous, local and systemic predisposing factors that disturbing ocular surface must be eliminated to improve corneal ulcers and to prevent recurrences. Smears and scrapings for staining and culture are indispensable diagnostic tools for cases of sight-threatening keratitis (centrally located, multifocal, characterized by melting, painful). Main treatment agents in bacterial keratitis treatment are topical antibiotics. Until the results of culture antibiograms reach the ophthalmologist, empirical antibiotic selections based on direct microscopic examination and gram stain findings are the most appropriate initial treatment approach currently. S. aureus and coagulase-negative staphylococci (CoNS), the most common gram-positive agents, have resistance rates of more than 30% for fluoroquinolone and methicillin. Multidrug resistance rates are similarly high in these microorganisms. P. aeruginosa is the most common gram-negative micro-organism, in case of multidrug-resistant isolates, both functional and anatomical prognosis of the eyes are very poor. In cases of sight-threatening and resistant keratitis, antibiotic susceptibility testing containing imipenem, colistin, and linezolid is seeming to be an important requirement. Despite its efficiency limited to superficial cases, a nonpharmaceutical anti-infective treatment option such as corneal crosslinking for bacterial keratitis is an emerging hope, while antibiotic resistance increases.

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Section: Risk Factorsmentioning

confidence: 99%

Section: The Challenge Of Diagnosismentioning

confidence: 99%

Section: When Are Smears and Culture Necessary?mentioning

confidence: 99%

Section: When Are Smears and Culture Necessary?mentioning

confidence: 99%

Section: Sample Collection For Smears and Culturementioning

confidence: 99%

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