Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review

Abstract

Importance Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. Background Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. Design Retrospective review of clinical records of patients with MK. Participants All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. Methods Trend in CLMK tested with chi‐squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. Main Outcome Measures Yearly rate of CLMK. Results Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15‐49 years) and corneal culture positive for P. aeruginosa Conclusions and Relevance The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.

Contact Lens Use Patterns, Behavior and Knowledge Among University Students in Thailand

“…37,38 Pseudomonas aeruginosa is the most common pathogen detected in CL-related microbial keratitis. 17,30 Interestingly, it has been detected in 524/ 7904 (6.6%) waters examined in hot tubs, tap water, jacuzzis, swimming pool and bottled water. 39 Fifty-one students (15.81%) reported using tap water for cleaning or rinsing lenses.…”

“…This phenomenon has also been observed in Singapore and Australia. 16,17 To date, little is known about CL wear and care status in Thailand, especially among university students. This survey aims to investigate the pattern, knowledge and behaviors of CL wear and care in Thai university students.…”

Current understanding and therapeutic management of contact lens associated sterile corneal infiltrates and microbial keratitis

“…For example, the fluoroquinolones (such as ciprofloxacin 0.3% four times a day) as prophylaxis would be an appropriate choice in Australia. 42,43 In contrast, chloramphenicol would not be appropriate due to its lack of coverage against Pseudomonas aeruginosa. [42][43][44] Practitioners should consider the local availability of antibiotics as well as the bacteria profile (such as patterns of resistance) in their practising environment when making prescribing decisions.…”

“…42,43 In contrast, chloramphenicol would not be appropriate due to its lack of coverage against Pseudomonas aeruginosa. [42][43][44] Practitioners should consider the local availability of antibiotics as well as the bacteria profile (such as patterns of resistance) in their practising environment when making prescribing decisions. The keratitis antimicrobial resistance surveillance programme in Sydney, Australia found low resistance to ciprofloxacin, supporting its value as the antibiotic of choice for empirical treatment of MK or other contact lens-related CIEs in Australia.…”

A turning point for contact lens‐associated microbial keratitis?

“…Microbial keratitis is a serious complication of contact lens wear, and lens wear is a common risk factor for corneal infection in developed countries. In a promising development, here, Green et al report that the number of contact lens‐related infections appears to be falling in Queensland. They believe the trend is due to the increasing use of daily disposable lenses.…”