Microbiological evaluation of corneal and contact lens cultures in contact lens-associated bacterial keratitis

Abstract

PurposeTo determine the degree of microbiological agreement between corneal scrapings and contact lens cultures in cases of contact lens-associated keratitis.MethodsElectronic medical records of all cases of contact lens-associated keratitis at a single institution from April 2006 to May 2019 were reviewed. Cases where both corneal scrapings and contact lens cultures were obtained were included in the study. Group 1 demonstrated agreement between corneal scrapings and contact lens cultures. Group 2 demonstrated growth on both cultures, but disagreement in isolated organism. Group 3 demonstrated negative corneal cultures but growth on contact lens cultures and the diagnostic yield of contact lens microbiological cultures and agreement between corneal and contact lens cultures.ResultsA total of 80 eyes of 72 patients were included in the study. 135 total incidences of microbiological results were included for data analysis. Group 1 contained nine incidences (6.7%), group 2 contained 60 incidences (44.4%) and group 3 contained 66 incidences (49%). In group 3, 50% of the cases were treated based on contact lens culture data. There was no statistically significant difference between all three groups in terms of baseline characteristics, presenting vision, vision at last follow-up, number of antibiotics used or complications from keratitis. Pseudomonas was the most common microorganism isolated, and in 89% of these cases, there was disagreement between corneal and contact lens cultures.ConclusionsAlthough there was a disagreement in the microbiological yield between contact lens and corneal cultures, contact lens cultures were useful in management of patients while achieving similar outcomes.

Comparative Evaluation of Pseudomonas aeruginosa Adhesion to a Poly-(2-Methacryloyloxyethyl Phosphorylcholine)-Modified Silicone Hydrogel Contact Lens

“…Our findings are relevant because CIEs, including contact lens-related keratitis and CLARE, are associated with Gram-negative pathogens, especially P. aeruginosa [ 2 , 7 , 9 , 10 , 65 ]. While keratitis can be caused by the microbiota resident to the eye, contact lenses are likely to function as a vector enabling the transfer of pathogenic microbes into the eye [ 31 , 101 ].…”

“…The disease can progress to corneal ulceration, scaring, and in severe circumstances, loss of vision [ 8 ]. Unfortunately, contact lens usage is associated with the development of microbial keratitis (CLMK) [ 2 , 7 , 9 , 10 ]. P. aeruginosa is the microorganism most frequently associated with CLMK [ 10 ].…”

Green nail syndrome complicated by pseudomonal keratitis in a teenager with artificial nails

“…Pseudomonas is the leading cause of contact lens‐associated bacterial keratitis 5 . Contact lenses serve as a vector for bacterial adherence, decrease corneal sensation, and can damage corneal epithelium, which predisposes to self‐inoculation from other sources such as GNS 5 . Both inappropriate daily contact lens and press‐on nail use can contribute to bacterial proliferation.…”

“…5 Contact lenses serve as a vector for bacterial adherence, decrease corneal sensation, and can damage corneal epithelium, which predisposes to self-inoculation from other sources such as GNS. 5 Both inappropriate daily contact lens and press-on nail use can contribute to bacterial proliferation. While official guidelines are lacking, most artificial nail manufacturers recommend using an antiseptic prior to application, avoiding prolonged water exposure, and removing the nails after 5-10 days.…”

Therapy for contact lens-related ulcers

“…Sampling from the leading edge of infection and direct inoculation into media provides the best yields [23 ▪▪ ,24]. Culturing contact lenses, cases, and solutions can be useful although studies have shown a wide range of concordance of results between corneal and contact lens case samples [23 ▪▪ ,25]. A sterile impression membrane may provide diagnostic yield similar to corneal scraping [26].…”