Enterobacter cloacae Keratitis: Clinicomicrobiological Profiles, Risk Factors, and Outcomes

Abstract

The purpose of the study was to report the clinical features, risk factors, antibiotic susceptibility, and treatment outcomes in a series of Enterobacter cloacae keratitis.Methods: A retrospective analysis was performed of the electronic medical records of microbial keratitis caused by E. cloacae identified by the Vitek 2 system (BioMerieux, Craponne, France). We collected data pertaining to demographics, risk factors, ulcer characteristics, antibiogram, visual acuity at presentation and final follow-up, and management outcome. The main outcome measure was resolution of infection. The final visual acuity was the secondary outcome measure.Results: Ten episodes of E. cloacae keratitis in 9 patients were identified between January 2009 and December 2019. Nine (90%) cases had undergone penetrating keratoplasty and 8 were failed grafts. Other risk factors included topical steroid use and irregular ocular surface due to epithelial bullae. The mean ulcer size was 17.55 6 13.99 mm 2 . More than 80% of isolates were sensitive to chloramphenicol, gentamicin, and colistin. Nine (90%) cases healed on medical management within 56.55 6 26.74 days (range 9-120 d), although almost all required adjunctive procedures: tissue adhesive application (n = 6) and/or tarsorrhaphy (n = 4). One case with a near total infiltrate had a mixed infection with Kocuria kristinae requiring therapeutic penetrating keratoplasty. One case developed endophthalmitis and phthisis after the corneal infiltrate resolved.Conclusions: E. cloacae keratitis is a rare clinical entity seen more often in immunocompromised host conditions such as failed corneal transplants with concomitant topical steroids. Most cases healed with medical management.

Effects of dietary imbalances of micro- and macronutrients on the ocular microbiome and its implications in dry eye disease

“…Diabetic conjunctival cultures are significantly more positive and have a higher prevalence of pathological organisms such as Staphylococcus aureus. This is clinically relevant because of the risk of introducing these organisms into the eye via intraocular procedures and may be one of the reasons why diabetic patients, in addition to their impaired immune function, have higher rates of post operative endophthalmitis [164].…”