Comparison of culture-positive and culture-negative severe infectious keratitis leading to hospitalization: a tertiary referral center experience

Yıl 2022, Cilt: 5 Sayı: 6, 1612 - 1618, 25.10.2022

Nesrin Tutaş Günaydın , Baran Kandemir , Gizem Dogan Gokce , Mehmet Can Özen , Raziye Dönmez Gün , Demet Hacıseyitoğlu

https://doi.org/10.32322/jhsm.1176813

Öz

Aim: To compare the predisposing factors, surgical interventions, length of hospital stay (LOHS), and treatment outcomes of culture-positive (CP) versus culture-negative (CN) severe infectious keratitis (IK) resulting in hospitalization in a tertiary referral clinic.
Material and Method: We retrospectively reviewed the medical and microbiological records of 287 patients clinically diagnosed with severe keratitis over a 4-year period.
Results: Of 287 study participants, 141 (49.1%) had positive CP results. The most common ocular risk factor was a previous ocular surgery (45.6%), and keratoplasty was the first among these ocular surgeries (90.8%). Staphylococcus epidermidis (22.7%) was the most commonly isolated microorganism followed by fungi (17.7%). The initial and final visual acuities did not differ significantly between the CP and CN groups. Major and minor surgical interventions did not significantly differ between the groups (p=0.05). The rates of clear corneal graft in the CP group (p =0.002) were significantly higher than the rates of graft failure in the CN group (p=0.033). No significant difference was noted in the mean LOHS between groups (p=0.66). Logistic regression analyses showed that surgery during admission, S. epidermidis infection, and connective tissue diseases were independent risk factors for a prolonged hospital stay.
Conclusion: The initial and final visual acuities, surgical interventions, and LOHS were similar between the CP and CN groups. However, graft failure rates were significantly higher in patients with CN keratitis than in those with CP keratitis.

Anahtar Kelimeler

Infectious keratitis, microbial culture, Staphylococcus epidermidis, hospitalization

Kaynakça

• Ung L, Bispo PJM, Shanbhag SS, Gilmore MS, Chodosh J. The persistent dilemma of microbial keratitis: global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 2019; 64: 255-71.
• Chidambaram JD, Venkatesh Prajna N, Srikanthi P, et al. Epidemiology, risk factors, and clinical outcomes in severe microbial keratitis in South India. Ophthalmic Epidemiol 2018; 25: 297-305.
• Puig M, Weiss M, Salinas R, Johnson DA, Kheirkhah A. Etiology and risk factors for infectious keratitis in South Texas. J Ophthalmic Vis Res 2020; 15: 128-37.
• Mohod PN, Nikose AS, Laddha PM, Shadwala Bharti. Incidence of various causes of infectious keratitis in the part of rural central India and its visual morbidity: prospective hospital-based observational study. J Clin Ophthalmol Res 2019; 7: 31.
• Ting DSJ, Ho CS, Deshmukh R, Said DG, Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond) 2021; 35: 1084-101.
• Wong T, Ormonde S, Gamble G, McGhee CN. Severe infective keratitis leading to hospital admission in New Zealand. Br J Ophthalmol 2003; 87: 1103-8.
• Jin H, Parker WT, Law NW, et al. Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital. Br J Ophthalmol 2017; 101: 1483-87.
• Jongkhajornpong P, Nimworaphan J, Lekhanont K, Chuckpaiwong V, Rattanasiri S. Predicting factors and prediction model for discriminating between fungal infection and bacterial infection in severe microbial keratitis. PloS One 2019; 14: e0214076.
• Tena D, Rodríguez N, Toribio L, González-Praetorius A. Infectious keratitis: microbiological review of 297 cases. Jpn J Infect Dis 2019; 72: 121-3.
• Egrilmez S, Yildirim-Theveny Ş. Treatment-resistant bacterial keratitis: challenges and solutions. Clin Ophthalmol 2020; 14: 287-97.
• Sharma S, Taneja M, Gupta R, et al. Comparison of clinical and microbiological profiles in smear-positive and smear-negative cases of suspected microbial keratitis. Indian J Ophthalmol 2007; 55: 21-5.
• Bhadange Y, Das S, Kasav MK, Sahu SK, Sharma S. Comparison of culture-negative and culture-positive microbial keratitis: cause of culture negativity, clinical features and final outcome. Br J Ophthalmol 2015; 99: 1498-502.
• Duarte MCB, Becker GN, Muller GG, Tuon FF. Infectious keratitis in southern Brazil: a comparison culture negative and culture positive patients. Rev Bras Oftalmol 2020; 79: 46-52.
• Stapleton F, Edwards K, Keay L, et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology 2012; 119: 1516-21.
• Thomas PA, Kuriakose T. Rapid detection of Acanthamoeba cysts in corneal scrapings by lactophenol cotton blue staining. Arch Ophthalmol 1990; 108: 168.
• Akova YA, Onat M, Koc F, Nurozler A, Duman S. Microbial keratitis following penetrating keratoplasty. Ophthalmic Surg Lasers 1999; 30: 449-55.
• Fransoo R, Martens P 2013. The Need to Know Team, Prior H, Burchill C, Koseva I, Bailly A, Allegro E. The 2013 RHA indicators atlas. Winnipeg, Canada: Manitoba Centre for Health Policy.
• Cariello AJ, Passos RM, Yu MCZ, Hofling-Lima AL. Microbial keratitis at a referral center in Brazil. Int Ophthalmol 2011; 31: 197-204.
• Hsiao CH, Sun CC, Yeh LK, et al. Shifting trends in bacterial keratitis in Taiwan: a 10-year review in a tertiary-care hospital. Cornea 2016; 35: 313-7.
• Yarımada S, Barut Selver Ö, Palamar M, et al. Comparison of culture-positive and -negative microbial keratitis. Turk J Ophthalmol 2022; 52: 1-5.
• Wagoner MD, Al-Swailem SA, Sutphin JE, Zimmerman MB. Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome. Ophthalmology 2007; 114: 1073-9.
• Dohse N, Wibbelsman TD, Rapuano SB, et al. Microbial keratitis and clinical outcomes following penetrating and endothelial keratoplasty. Acta Ophthalmol 2020; 98: e895-e900.
• Roongpoovapatr V, editor. Infectious keratitis: the great enemy. Visual impairment and blindness-what we know and what we have to know. IntechOpen, 2019.
• Lin L, Lan W, Lou B, et al. Genus distribution of bacteria and fungi associated with keratitis in a large eye center located in Southern China. Ophthalmic Epidemiol 2017; 24: 90-6.
• Augustin VA, Weller JM, Kruse FE, Tourtas T. Fungal interface keratitis after descemet membrane endothelial keratoplasty. Cornea 2018; 37: 1366-9.
• Lim NCS, Lim DKA, Ray M. Polymicrobial versus monomicrobial keratitis: a retrospective comparative study. Eye Contact Lens 2013; 39: 348-54.
• Otri AM, Fares U, Al‐Aqaba MA, et al. Profile of sight‐threatening infectious keratitis: a prospective study. Acta Ophthalmol 2013; 91: 643-51.
• Koh YY, Sun CC, Hsiao CH. Epidemiology and the estimated burden of microbial keratitis on the health care system in Taiwan: a 14-year population-based study. Am J Ophthalmol 2020; 220: 152-9.
• Toriyama K, Suzuki T, Shiraishi A. Characteristics of infectious keratitis in old and very old patients. J Ocul Pharmacol Ther 2018; 34: 565-9.
• Khoo P, Cabrera-Aguas MP, Nguyen V, Lahra MM, Watson SL. Microbial keratitis in Sydney, Australia: risk factors, patient outcomes, and seasonal variation. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1745-55.
• Lin TY, Yeh LK, Ma DHK, et al. Risk factors and microbiological features of patients hospitalized for microbial keratitis: a 10-year study in a referral center in Taiwan. Medicine 2015; 94: e1905.
• Tóth G, Pluzsik MT, Sándor GL, et al. Clinical review of microbial corneal ulcers resulting in enucleation and evisceration in a tertiary eye care center in Hungary. J Ophthalmol 2020; 2020: 8283131.