Clinical and Microbiological Characteristics of Bacterıal Keratitis in Our Region

Abstract

Objectives: To review the clinical and microbiological characteristics of bacterial keratitis in our ophthalmology department. Materials and methods: A retrospective analysis of the hospital records of 32 patients presenting with bacterial keratitis were analysed from January 2005 to January 2007. Results: The mean age of the patients were 53, 6±24, 9 and 52, 25% (18) were older than 65 years. Presenting mean visual acuity was 0, 085±0, 185 log mar and mean final visual acuity was 0, 145±0, 299 log mar. As a major ocular risk factor, trauma was defined in 15, 7% ( 5) patients. An organism was defined in 34, 3% (11) patients. 73% (8) and 27% (3) of the isolates were Gram positive and Gram negative bacteria, respectively. Streptococcus species were the most common isolates (7, 64%). Most of the bacterial isolates remained sensitive to currently availableantibiotic preparations. 93, 7% (30) of keratitis healed with therapy and 86, 6% (26) of patients had visual acuity the same or better than the level at admission. 6, 3% (2) had very poor visual outcome and keratoplasty were performed. Conclusion: Most of our patients with bacterial keratitis were healed with appropriate treatment. Trauma was the most important ocular risk factor. Elder population has an increased risk of developing keratitis.©2008, Firat University, Medical Faculty.

Keywords

• -

Yöremizdeki Bakteriyel Keratitlerin Klinik Ve Mikrobiyolojik Özellikleri

Öz

Amaç: Oftalmoloji kliniğimizdeki bakteriyel keratitlerin klinik ve mikrobiyolojik özelliklerini incelemek. Gereç ve Yöntem: Ocak 2005 ve Ocak 2007 yılları arasında bakteriyel keratit tanısı alan 32 hastanın kayıtları retrospektif olarak incelendi. Bulgular: Hastaların ortalama yaşı 53, 6±24, 9 ve %52, 25 (18)' i 65 yaşından daha yaşlı idi. İlk geliş görme keskinlikleri 0, 085±0, 185 log mar, son görme keskinlikleri ise 0, 145±0, 299 log mar arasında idi. En önemli oküler risk faktörü olarak %15, 7 (5) hastada travma saptandı. %34, 3 (11) hastada organizma tanımlandı. İzolatların sırasıyla %73 (8)'ü Gram pozitif, %27 (3)'si Gram negatif idi. Streptococcus türleri en yaygın izolat idi (7, %64). İzole edilen bakterilerin çoğu günümüzde yaygın olarak kullanılan antibiyotiklere duyarlı idi. %93, 7 (30) keratit tedavi ile iyileşti ve %86, 6 (26) hastada görme keskinliği müracaat anındaki seviyede ya da bundan daha iyi idi. %6, 3 (2) hastada görsel sonuçlar çok kötü oldu ve bunlara keratoplasti yapıldı. Sonuç: Bakteriyel keratitli hastalarımızın çoğu uygun tedavi ile iyileşti. Travma en önemli oküler risk faktörü idi. Yaşlı popülasyon keratit açısından artmış risk taşımaktadır.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Antibakteriyel tedavi, bakteriyel keratit, kültür

References

1. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: A globalperspective. Bull World Health Organ 2001; 79: 214-221.
2. Benson WH, Lanier JD. Current diagnosis and treatment of corneal ulcers. Curr Opin Ophthalmol 1998; 9: 45-49.
3. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: A prospective clinical and microbiological study. Br J Ophthalmol 2001; 85: 842-847
4. Bourcier T, Thomas F, Borderie V, Chaumeil C, Laroche L. Predisposing Bacterial microbiological review of 300 cases. Br J Ophtalmol 2003; 87: 834-838 factors, clinical and
5. Doğru M, Baykara M, Aygül F, Özmen A, Ertürk H, Özçetin H. Bakteriyel keratitli olgularda klinik deneyimimiz. Türkiye Klinikleri Oftalmoloji 2003; 12: 208-214
6. Yılmaz S, Öztürk I, Türe M, Maden A. Mikrobiyal keratit tedavisinde 16 yıl. Türkiye Klinikleri Oftalmoloji 2008; 17: 1-6
7. Yalçın E, Karel F, Karaarslan A, Tekeli A. Kornea enfeksiyonlarının antibiyogramın önemi. Medikal Network Oftalmoloji 1998; 5: 42-46. direk yayma, kültür ve
8. Hyndiuk RA, Eiferman RA, Caldwell DR et al. Comparison of ciprofloxacin ophthalmic solution 0.3% to fortified tobramycin- cefazolin in treating bacterial corneal ulcers. Ciprofloxacin Bacterial Keratitis Study Group. Ophthalmol 1996; 103: 1854- 1862

9. Mallari PL, McCarty DJ, Daniell M, Taylor M. Increased incidence of corneal perforation after topical fluoroquinolone treatment for microbial keratitis. Am J Ophthalmol 2001; 131: 131-133.
10. Sharma V, Sharma S, Garg P, Rao GN. Clinical resistance of Staphylococcus keratitis to ciprofloxacin monotherapy. Indian J Ophthalmol 2004; 52: 287-292.
11. Chaudhuri PR, Godfrey B. Treatment of bacterial corneal ulcers with concentrated antibiotic eye drop. Trans Ophthalmol Soc UK 1982; 102: 11-14
12. Alfonso E, Crider J. Ophthalmic infections and their anti- infective challenges. Surv of Ophthalmol 2005; 50: 51-56
13. Cohen EJ, Fulton JC, Hoffman CJ, Rapuano CJ, Laibson PR. Trends in contact lens-associated corneal ulcers. Cornea 1996; 15: 566-570
14. Coster DJ, Badenoch PR. Host, microbial, and pharmacological factors affecting the outcome of suppurative keratitis. Br J Ophthalmol 1987; 71: 96-101.
15. Dart JK, Stapleton F, Minassian D. Contact lenses and other risk factors in microbial keratitis. Lancet 1991; 338: 650-653.
16. Vajpayee RB, Dada T, Saxena R, Vajpayee M, Taylor HR, Vankatesh P, Sharma N. Study of the first contact management profile of cases of infectious keratitis: A hospital-based study. Cornea 2000; 19: 52-56.
17. Butler TKH, Spencer NA, Chan CCK, Singh Gilhotra J, McClellan K. Infective keratitis in older patients: A 4 year review, 1998–2002. Br J Ophtalmol 2005; 89: 591-596
18. Oral Y, Özkurt Y, Rodop Ö, Benzonana N, Ustaoğlu R, Doğan ÖK. Enfeksiyöz keratitlerin tedavisinde kültür ve antibiyogramın rolü. Türk Oftalmoloji Gazetesi 2001; 31: 18-21
19. Kabul Tarihi:13.06.2008