Lesson of the week: microbial keratitis in intensive care

Kirwan, JF; Potamitis, T; El-Kasaby, H T; Hope–Ross, M.; Sutton, G A

doi:10.1136/bmj.314.7078.433

Cited by 40 publications

(34 citation statements)

References 5 publications

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“…These factors often result in incomplete lid closure and consequent exposure keratopathy. [1][2][3][4] Whereas a conscious patient with intact corneal sensation will experience and report symptoms from even minor corneal damage, corneal disease may go unrecognised in comatoseventilated patients until it reaches an advanced stage.…”

Section: Introductionmentioning

confidence: 99%

“…A literature review revealed reports of 22 patients who developed bacterial keratitis in intensive care, which in seven patients was bilateral. 3,7,[12][13][14][15] In the largest series, the mean visual acuity of six surviving patients at discharge was 6/60. 12 Although there is likely to be a significant reporting bias in favour of more severe cases among published case reports, it remains striking that so many of these cases were bilateral, with substantially worse outcomes than would be expected in an outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

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Screening for ocular surface disease in the intensive care unit

McHugh

Alexander

Kalhoro

et al. 2007

Eye

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Purpose Ventilated patients in the intensive care unit (ICU) often develop exposure keratopathy. This predisposes to the development of bacterial keratitis, which in ICU is often bilateral, with a high risk of perforation. As regular examinations of all ventilated patients by ophthalmologists would be impractical, the purpose of this study was to assess whether ICU staff can screen reliably for keratopathy. Methods A prospective study was performed in a general adult ICU. Twice each week, two junior ICU doctors examined the lid position and ocular surface of all patients who had been continuously sedated for more than 24 h, using fluorescein and a pen torch with a blue filter. An ophthalmologist performed similar examinations using a portable slit lamp. Results A total of 48 ocular examinations were performed in 18 patients. Exposure keratopathy was found by the ophthalmologist in 37.5% of examinations and by ICU doctors in 31.3% of examinations. ICU doctors had a sensitivity of 77.8% and a specificity of 96.7% in detecting keratopathy, when compared with the findings of the ophthalmologist. All cases missed by ICU doctors had punctate erosions of less than 5% of the corneal surface. Keratopathy was significantly commoner in patients with incomplete lid closure than in patients with closed lids (70.0 vs 28.9%; two-tailed Fisher's exact test P ¼ 0.027). Conclusions ICU staff can perform screening examinations for exposure keratopathy with reasonable sensitivity and specificity. Regular screening by ICU staff would facilitate appropriate treatment of exposure keratopathy and promote earlier identification of cases of keratitis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Screening for ocular surface disease in the intensive care unit

McHugh

Alexander

Kalhoro

et al. 2007

Eye

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“…Finally, in cases involving severe infections leading to visual loss, corneal transplantation may be required [60][61][62][63].…”

Section: Vignettes In Patient Safety -Volumementioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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“…Sebagai patogen nosokomial, dapat terjadi kolonisasi dan infeksi pada penderita yang di rawat di rumah sakit (4,5,6). Infeksi berupa pneumonia (3,7), infeksi mata (8,9), infeksi luka bakar atau luka bedah, infeksi kulit, infeksi saluran kemih, bakteremia dan septikemia (3).…”

Section: Pendahuluanunclassified

PROTEIN FIMBRIA 16 kDa BAKTERI ACINETOBACTER BAUMANNIIDARI URIN PENDERITA INFEKSI SALURAN KEMIH BERPERAN SEBAGAI PROTEIN HEMAGLUTININ DAN ADHESIN

Noorhamdani

2013

JKB

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Acinetobacter baumannii (Acb) is an opportunistic and nosocomial pathogen that ussualy found in clinical specimen from patients with intensive care. The pathogenic mechanism of this bacteria are not fully elucidated especially potential activity of its protein as hemaglutinin and adhesion molecul. The aim of this study is to evaluate the role of 16 kDa fimbriae protein from urnary tract infection (UTI) patient as hemaglutinin and adhesion molecule. Using explorative design this study was started by isolation Acb bacteria from urine of patient that had been determine as UTI clinically and laboratory. After identification this bacteria by microbact system hemaglutination test and isolation of its fimbriae fraction, 12.5% SDS-PAGE had been used to isolated fimbriae protein, following assay in vitro to adhesion test.. The study showed that the 16 kDa fimbriae protein of Acb bacteria was a hemaglutinin protein that could agglutinate 0.5% mice erythrocytes (1/32), and human blood group O erythrocytes (1/8). Hemaglutination test were negative on erythrocytes from rat, guinea pig, sheep, and human blood group A, B. The 16 kDa fimbriae protein (AF16) was also adhesion protein that had been revealed by its activity to adherence to receptor of mice enterocytes. The increasing dose of AF16 molecules will decrease the amount of Acb bacteria to adherence to enterocytes (p<0.05). The fimbriae of Acb is maybe classified P type.

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Lesson of the week: microbial keratitis in intensive care

Cited by 40 publications

References 5 publications

Screening for ocular surface disease in the intensive care unit

Screening for ocular surface disease in the intensive care unit

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

PROTEIN FIMBRIA 16 kDa BAKTERI ACINETOBACTER BAUMANNIIDARI URIN PENDERITA INFEKSI SALURAN KEMIH BERPERAN SEBAGAI PROTEIN HEMAGLUTININ DAN ADHESIN

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