Management of bacterial keratitis: beyond exorcism towards consideration of organism and host factors

O’Brien, Terrence P.

doi:10.1038/sj.eye.6700635

Cited by 67 publications

(59 citation statements)

References 116 publications

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“…This invasion is facilitated via proteases, exotoxins resulting in degradation of basement membrane and extracellular matrix, causing cells to lyse. A number of exotoxins including heat-stable haemolysin, phospholipases, exotoxins play a role in invasion of bacteria into the cornea with eventual stromal necrosis [133]. Once bacterial invasion into the cornea has ensued, the infection progresses rapidly towards melting of cornea facilitated by bacterial proteases, activation of metalloproteases and stimulation of immune response resulting in further damage via release of reactive oxygen intermediates and host proteases [114,192].…”

Section: Bacterial Invasion and Cytotoxic Effectsmentioning

confidence: 99%

“…The frequency of application of antibiotic drops depends on the severity of infection but usually they are administered every half an hour for the first 24-36 h [51,133]. In severe cases, an initial loading dose is achieved via a drop every 5 min for the first 30 min.…”

Section: Treatmentmentioning

confidence: 99%

“…The use of corticosteroids as anti-inflammatory agents are controversial and are best avoided until the infection is completely eradicated or at least under control [51,133]. In patients with corneal ulceration the use of non-steroidal anti-inflammatory drugs should also be avoided due to increased risk of corneal melting and perforation.…”

Section: Treatmentmentioning

confidence: 99%

“…In case of progressive corneal thinning or perforations, less than 2 mm cyanoacrylate tissue adhesives may be used, which may also have some inherit antibacterial activity as well [41,51,93,133]. Tissue adhesives are only suitable for small perforations, as they are toxic to corneal endothelium.…”

Section: Treatmentmentioning

confidence: 99%

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Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

167

121

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Microbial keratitis is a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. Epithelial defects and injuries are key predisposing factors making the eye susceptible to corneal pathogens. Among bacterial pathogens, the most common agents responsible for keratitis include Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumonia and Serratia species. Fungal agents of corneal infections include both filamentous as well as yeast, including Fusarium, Aspergillus, Phaeohyphomycetes, Curvularia, Paecilomyces, Scedosporium and Candida species, while in protists, Acanthamoeba spp. are responsible for causing ocular disease. Clinical features include redness, pain, tearing, blur vision and inflammation but symptoms vary depending on the causative agent. The underlying molecular mechanisms associated with microbial pathogenesis include virulence factors as well as the host factors that aid in the progression of keratitis, resulting in damage to the ocular tissue. The treatment therefore should focus not only on the elimination of the culprit but also on the neutralization of virulence factors to minimize the damage, in addition to repairing the damaged tissue. A complete understanding of the pathogenesis of microbial keratitis will lead to the rational development of therapeutic interventions. This is a timely review of our current understanding of the advances made in this field in a comprehensible manner. Coupled with the recently available genome sequence information and high throughput genomics technology, and the availability of innovative approaches, this will stimulate interest in this field.

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Section: Bacterial Invasion and Cytotoxic Effectsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Pathogenesis of microbial keratitis

Lakhundi

Siddiqui

Khan

2017

Microbial Pathogenesis

167

121

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“…This results in a requirement for multiple administrations sometimes at 3-4 intervals per hour over a 24 h period often with an initial dose every 5 min for the fi rst 30-60 min. [ 9,10 ] There could be major advantages in the design and use of slow release antimicrobials from a bandage contact lens material as a more effi cient delivery method. [ 11,12 ] Corneal bandage materials include collagen, amniotic membrane-derived materials, and advanced hydrogel polymers.…”

Section: Doi: 101002/adhm201600258mentioning

confidence: 99%

A Novel Peptide Hydrogel for an Antimicrobial Bandage Contact Lens

Gallagher

Alorabi

Wellings

et al. 2016

Adv Healthcare Materials

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A peptide hydrogel with an antimicrobial activity is developed as a bandage contact lens. The antimicrobial activity is enhanced with the addition of the biomolecules penicillin G or poly‐ε‐lysine and is positive against Staphylococcus aureus and Escherichia coli. The lens is also noncytotoxic toward a human corneal epithelial cell line and as a consequence is of great potential as a drug‐eluting bandage lens replacing conventional corneal ulcer treatment.

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Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

et al. 2023

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ImportanceNeighborhood-level social risk factors may contribute to health disparities in microbial keratitis (MK) disease presentation. Understanding neighborhood-level factors may identify areas for revised health policies to address inequities that impact eye health.ObjectiveTo investigate if social risk factors were associated with presenting best-corrected visual acuity (BCVA) for patients with MK.Design, Setting, and ParticipantsThis was a cross-sectional study of patients with a diagnosis of MK. Patients presenting to the University of Michigan with a diagnosis of MK between August 1, 2012, and February 28, 2021, were included in the study. Patient data were obtained from the University of Michigan electronic health record.Main Outcomes and MeasuresIndividual-level characteristics (age, self-reported sex, self-reported race and ethnicity), presenting log of the minimum angle of resolution (logMAR) BCVA, and neighborhood-level factors, including measures on deprivation, inequity, housing burden, and transportation at the census block group, were obtained. Univariate associations of presenting BCVA (&lt; 20/40 vs ≥20/40) with individual-level characteristics were assessed with 2-sample t, Wilcoxon, and χ2 tests. Logistic regression was used to test associations of neighborhood-level characteristics with the probability of presenting BCVA worse than 20/40 after adjustment for patient demographics.ResultsA total of 2990 patients with MK were identified and included in the study. Patients had a mean (SD) age of 48.6 (21.3) years, and 1723 were female (57.6%). Patients self-identified with the following race and ethnicity categories: 132 Asian (4.5%), 228 Black (7.8%), 99 Hispanic (3.5%), 2763 non-Hispanic (96.5%), 2463 White (84.4%), and 95 other (3.3%; included any race not previously listed). Presenting BCVA had a median (IQR) value of 0.40 (0.10-1.48) logMAR units (Snellen equivalent, 20/50 [20/25-20/600]), and 1508 of 2798 patients (53.9%) presented with BCVA worse than 20/40. Patients presenting with logMAR BCVA less than 20/40 were older than those who presented with 20/40 or higher (mean difference, 14.7 years; 95% CI, 13.3-16.1; P &lt; .001). Furthermore, a larger percentage of male vs female sex patients presented with logMAR BCVA less than 20/40 (difference, 5.2%; 95% CI, 1.5-8.9; P = .04), as well as Black race (difference, 25.7%; 95% CI, 15.0%-36.5%;P &lt; .001) and White race (difference, 22.6%; 95% CI, 13.9%-31.3%; P &lt; .001) vs Asian race, and non-Hispanic vs Hispanic ethnicity (difference, 14.6%; 95% CI, 4.5%-24.8%; P = .04). After adjusting for age, self-reported sex, and self-reported race and ethnicity, worse Area Deprivation Index (odds ratio [OR], 1.30 per 10-unit increase; 95% CI, 1.25-1.35; P &lt; .001), increased segregation (OR, 1.44 per 0.1-unit increase in Theil H index; 95% CI, 1.30-1.61; P &lt; .001), higher percentage of households with no car (OR, 1.25 per 1 percentage point increase; 95% CI, 1.12-1.40; P = .001), and lower average number of cars per household (OR, 1.56 per 1 less car; 95% CI, 1.21-2.02; P = .003) were associated with increased odds of presenting BCVA worse than 20/40.Conclusion and RelevanceFindings of this cross-sectional study suggest that in a sample of patients with MK, patient characteristics and where they live were associated with disease severity at presentation. These findings may inform future research on social risk factors and patients with MK.

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Management of bacterial keratitis: beyond exorcism towards consideration of organism and host factors

Cited by 67 publications

References 116 publications

Pathogenesis of microbial keratitis

Pathogenesis of microbial keratitis

A Novel Peptide Hydrogel for an Antimicrobial Bandage Contact Lens

Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

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