Severe infective keratitis leading to hospital admission in New Zealand

Abstract

Aim: To identify key risk factors and the management and outcome of severe infective keratitis leading to public hospital admission in New Zealand. Methods: Over a 2 year period, all admissions of presumed infective keratitis to Auckland Hospital were identified. The clinical records of all 103 cases were retrospectively reviewed with respect to clinical features, risk factors, management, and outcomes. Results: The mean time from first symptoms or signs and presentation to hospital was 8.9 (SD 15.5) days. The majority of subjects, 88%, had at least one of the risk factors commonly associated with infective keratitis including previous ocular surgery (30%), contact lens wear (26%), topical corticosteroid use (25%), and ocular trauma (24%). Corneal scraping was performed in 92% and of a total of 105 scrapes, 71% were positive. Bacteria were isolated in all these cases, the majority being Gram positive organisms (72%). The most common isolates identified were coagulase negative Staphylococcus (16%), Propionibacterium acnes (14%), Staphylococcus epidermidis (11%), and Streptococcus pneumoniae (9%). In addition, yeasts were isolated in 5%, fungi in 4%, virus in 2%, and chlamydia in 1%. Importantly, polymicrobial infection accounted for 33% of culture positive cases. Antimicrobial treatment was changed on the basis of culture results in 17 cases (16.5%). Median initial visual and final best corrected visual acuity was 6/36-6/48 (logMAR 0.86) (IQR 0.39-2.00) and 6/12-6/15 (logMAR 0.360) (IQR 0.15-1.70), respectively. Previous ocular surgery and topical corticosteroid use were significantly associated with poorer visual acuity. The mean hospital stay was 5.8 days and the median 4.0 (IQR 2.0-8.0) days. Longer duration of stay was associated with the presence of hypopyon, larger ulcers, previous ocular surgery, and poor visual acuity. Conclusions: Infectious keratitis is an important cause of ocular morbidity. A significant proportion of cases have potentially modifiable risk factors. Previous ocular surgery and topical corticosteroid use, in particular, were associated with poorer visual outcomes. Many cases of severe keratitis might be avoided, or their severity reduced, by appropriate education of patients and ophthalmologists.

Eye preservation tectonic graft using glycerol-preserved donor cornea

“…[15][16][17][18][19][20] In the current study, postoperative bullous keratoplasty (9/14, 64.3%) was the major risk factor for keratitis due to ocular surface diseases with recurrent erosion of the epithelium. 21,22 Fusarium infection is the most common pathogen leading to cornea perforation (28.8%), followed by P. aeruginosa keratitis (21.4%). This is consistent with the literature that Pseudomonas and Fusarium keratitis are the most virulent and rapid progressive pathogens.…”

Characteristics of and risk factors for contact lens-related microbial keratitis in a tertiary referral hospital

“…[1][2][3][4][5][6][7][8]13,19 It should be remembered that the age range here was restricted to 15-64 years and would, therefore, under- Eye represent other causes of MK in older individuals associated with ocular surface or systemic disease. The RVEEH is a tertiary referral hospital and cases here may also represent the more severe spectrum of disease.…”

“…Depending on study design and location, contact lens wear now accounts for between 12.4 and 66% [1][2][3][4][5][6][7][8] of all infective keratitis and up to 93% of all Acanthamoeba keratitis. [9][10][11] To understand further and reduce the risk of infection, a number of large-scale epidemiological studies have investigated the risk factors for MK in contact lens wearers.…”

“…2,6 This may be a reflection of more severe lesions seen at a tertiary referral centre, or of different culturing practices in different hospitals.…”

Variable expression of immunoreactive surface proteins of Propionibacterium acnes

“…In addition it has been used as an anti-tumour agent in humans (Davies, 1982). P. acnes is implicated in inflammatory diseases such as acne vulgaris (Ingham, 1999), sarcoidosis (Moller & Chen, 2002), keratitis (Wong et al, 2003), synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome (Kirchhoff et al, 2003), endocarditis (Brook, 2002), and potentially fatal granuloma after trauma (Gao et al, 2002). It is also frequently present in medical implant biofilm infection (Tunney et al, 1999;Zedtwitz-Liebenstein et al, 2003).…”