Practice patterns in the management of fungal and acanthamoeba keratitis: a five‐continent survey

Wespiser, Simon; Fabacher, Thibaut; Gomart, Gabrielle; Sauer, Arnaud; Bourcier, Tristan

doi:10.1111/aos.14747

Cited by 3 publications

(4 citation statements)

References 5 publications

(6 reference statements)

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“…However, four out of five ophthalmologists would use a combination of two or more antibiotics and one out of five a fluoroquinolone monotherapy. 26 Considering the antibiotic resistance levels found in the present study, our first-line treatment associating fortified ticarcillin/ piperacillin, gentamycin, and vancomycin may not be relevant as the level of resistance was found to be 59% for aminoglycosides and 73% for ticarcillin. An association of fluoroquinolone with vancomycin would provide broad-spectrum anti-bacterial treatment with low resistance.…”

Section: Discussionmentioning

confidence: 57%

“…Therapeutic management of severe bacterial keratitis features geographic disparities, and no global consensus is available for the first‐line topical antibiotics to be used. However, four out of five ophthalmologists would use a combination of two or more antibiotics and one out of five a fluoroquinolone monotherapy 26 . Considering the antibiotic resistance levels found in the present study, our first‐line treatment associating fortified ticarcillin/piperacillin, gentamycin, and vancomycin may not be relevant as the level of resistance was found to be 59% for aminoglycosides and 73% for ticarcillin.…”

Section: Discussionmentioning

confidence: 66%

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Infectious keratitis following corneal transplantation: A long‐term cohort study

Ittah‐Cohen,

Knoeri,

Bourcier

et al. 2024

Clinical Exper Ophthalmology

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BackgroundTo assess the long‐term incidence and risk factors for post‐keratoplasty infectious keratitis (IK), associated ocular pathogens, and antibiotic resistance profiles.MethodsCohort study including 2553 consecutive penetrating, endothelial, and anterior lamellar keratoplasties performed between 1992 and 2020. Medical and microbiological records of patients clinically diagnosed with IK were retrospectively reviewed. Main outcome measures: cumulative incidence of IK, infectious agent species, and antibiotics resistance profiles.ResultsThe average follow‐up time after transplantation was 112 ± 96 months. Eighty‐nine IK episodes were recorded; microbiological tests were positive in 55/89 (62%). The cumulated incidence of postoperative IK was 5.50%/10.25% at 10/20 years. The occurrence of at least one episode of IK after transplantation was associated with lower graft survival in the long term (p < 0.0001). Rejection risk (adjusted Hazard Ratio, 2.29) and postoperative epithelial complications (HR, 3.44) were significantly and independently associated with a higher incidence of postoperative IK. Infectious agents included 41 bacteria, 10 HSV, 6 fungi, and 1 Acanthamoeba. The rate of antibiotic resistance was 0% for vancomycin, 13% for fluoroquinolones, 20% for rifamycin, 59% for aminoglycosides, and 73% for ticarcillin. In 41% of cases, patients were under prophylactic topical antibiotics before the infectious episode. Topical antibiotics were significantly associated with increased resistance to penicillin, carbapenems, and aminoglycosides.ConclusionIK (mainly bacterial) is a frequent complication of corneal transplantation in the long term. Vancomycin and fluoroquinolones can be considered as first‐line treatments. Prolonged postoperative antibiotic preventive treatment is not advisable as it may increase antibiotic resistance.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 66%

Infectious keratitis following corneal transplantation: A long‐term cohort study

Ittah‐Cohen,

Knoeri,

Bourcier

et al. 2024

Clinical Exper Ophthalmology

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“…Increased AK awareness and diagnosis has resulted in the disease being increasingly recognized on a global scale [14][15][16][17][18]. However, there does not appear to be a globally systematic method of AK diagnosis and treatment, resulting in widespread variations in management worldwide [19]. Furthermore, because of its global prevalence, notable variations in risk factors and microbial epidemiology exist across different regions [11,20].…”

Section: Introductionmentioning

confidence: 99%

“…As a result, differences in the pathogenesis of the disease can lead to regional differences in treatment efficacy. Additionally, certain antimicrobial agents and diagnostic modalities are not universally accessible [19].…”

Section: Introductionmentioning

confidence: 99%

New Frontiers in Acanthamoeba Keratitis Diagnosis and Management

Shareef,

Saeed

2023

Biology

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Acanthamoeba Keratitis (AK) is a severe corneal infection caused by the Acanthamoeba species of protozoa, potentially leading to permanent vision loss. AK requires prompt diagnosis and treatment to mitigate vision impairment. Diagnosing AK is challenging due to overlapping symptoms with other corneal infections, and treatment is made complicated by the organism’s dual forms and increasing virulence, and delayed diagnosis. In this review, new approaches in AK diagnostics and treatment within the last 5 years are discussed. The English-language literature on PubMed was reviewed using the search terms “Acanthamoeba keratitis” and “diagnosis” or “treatment” and focused on studies published between 2018 and 2023. Two hundred sixty-five publications were initially identified, of which eighty-seven met inclusion and exclusion criteria. This review highlights the findings of these studies. Notably, advances in PCR-based diagnostics may be clinically implemented in the near future, while antibody-based and machine-learning approaches hold promise for the future. Single-drug topical therapy (0.08% PHMB) may improve drug access and efficacy, while oral medication (i.e., miltefosine) may offer a treatment option for patients with recalcitrant disease.

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Practice patterns in the management of bacterial keratitis: a five-continent survey

Wespiser

Koestel

Fabacher³

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Practice patterns in the management of fungal and acanthamoeba keratitis: a five‐continent survey

Cited by 3 publications

References 5 publications

Infectious keratitis following corneal transplantation: A long‐term cohort study

Infectious keratitis following corneal transplantation: A long‐term cohort study

New Frontiers in Acanthamoeba Keratitis Diagnosis and Management

Practice patterns in the management of bacterial keratitis: a five-continent survey

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