Clinical and microbiological characteristics of corneal ulcers in a Thai referral center

Abstract

Background: There are regional variations in causative organisms and epidemiologic patterns of corneal ulcers. It is essential to review periodically in terms of epidemiology and the microbial keratitis profiles that occur in a specific region in order to develop a comprehensive strategy for diagnosis and management of corneal ulcers. Objective: To review the epidemiology, predisposing factors, microbiological characteristics and visual outcomes in corneal ulcers at a referral center in Thailand. Methods: A retrospective review of patients with clinically diagnosed corneal ulcers presenting between January 2006 and December 2010 was performed. Results: A total of 159 patients (159 eyes) were analyzed. Ninety-one cases (57.2%) were in men. The mean age of the patients was 43.0 ± 20.0 years. The most common predisposing factor was ocular trauma found in 72 eyes (45%). Culture was grown from 123 eyes and results were positive in 52%. The most frequent causative organisms were bacteria (72%), followed by fungus (28%). The most common bacteria was Pseudomonas aeruginosa (55%) and most common fungus was Fusarium species (33%). In a comparison between fungal and bacterial groups, the latter was more likely to be associated with contact lens wear (p = 0.05). The hospitalization time for the fungal group was significantly longer than for the bacterial group (p = 0.001). The posttreatment corrected visual acuity equal to or better than 20/200 was found significantly more commonly in the bacterial group than in the fungal group (p = 0.031). While therapeutic keratoplasty was significantly higher in the fungal group than in the bacterial group (p = 0.048). Conclusion: Fungal keratitis was more severe than bacterial keratitis resulting in longer hospitalization time, poorer visual acuity, and with more chance to have therapeutic keratoplasty.

Contact Lens Associated Bacterial Keratitis: Common Organisms, Antibiotic Therapy, and Global Resistance Trends: A Systematic Review

“…The selection process of articles is shown in Figure 1. Twenty-six articles were included and classified into the following: 15 retrospective reviews of patients (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), seven prospective reviews of patients (30)(31)(32)(33)(34)(35)(36), three cross-sectional studies (37)(38)(39), and one case series (40). Four studies have been conducted in Iran; three in India; two studies in the USA, Australia, Netherlands, China; and one study each in Switzerland, Portugal, Pakistan, Thailand, Brazil, Turkey, France, Egypt, UK, Japan, and Belgium (Table 1).…”

Bacterial etiology and antimicrobial resistance trends in ocular infections: A 30-year study, Turin area, Italy

“…Among keratitis, Pseudomonas spp. were the most isolated pathogens (28%) as reported in Ireland (33%), 16 the United Kingdom (24.3%–28.4%), 13,14 Israel (16%), 23 Iran (24.7%), 25 China (28%–32.2%), 8,9 Thailand (55%), 24 and Australia (21%). 22…”

“…Among the Gram-positive bacteria, Staphylococcus aureus , coagulase-negative staphylococci (CoNS), Streptococcus pneumonia , and Streptococcus pyogenes represent the leading species isolated worldwide; Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli , and Haemophilus influenzae are the main Gram-negative bacteria isolated from ocular infections. 7–27…”

Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations

“…Even with prompt intervention, patients can experience significant morbidity and ocular complications such as corneal scarring or perforation, endophthalmitis, and vision loss . The care for corneal ulcers can present a significant economic and logistic burden for the patient and health care system . In the US, nearly 1 million health care visits for keratitis or contact lens complications are reported to occur annually in office, outpatient, and emergency department visits, with an estimated direct health care expenditure of approximately $175 million…”

“…3,4 The care for corneal ulcers can present a significant economic and logistic burden for the patient and health care system. [5][6][7][8] In the US, nearly 1 million health care visits for keratitis or contact lens complications are reported to occur annually in office, outpatient, and emergency department visits, with an estimated direct health care expenditure of approximately $175 million. 5 Although a large majority of patients with corneal ulcers can be effectively treated in an outpatient setting, hospitalization may be warranted in cases of (1) delayed diagnosis or treatment, (2) gonococcal infections requiring systemic antibiotics, or (3) no support system for patients to help with treatment compliance.…”