Delhi Infectious Keratitis Study

Abstract

Purpose: To study the clinico-microbiological profile and outcomes of infectious keratitis (IK) at a tertiary eye care center in North India. Methods: This is a retrospective, hospital-based, cross-sectional study. One thousand seven hundred and eighty-six corneal microbiological reports were identified from January 2017 to December 2018, out of which 625 patients of IK fulfilled the inclusion criteria. They underwent microbiological examination which included corneal scrapings, culture, and antibiotic sensitivity. Demographic features, signs and symptoms, risk factors such as associated trauma, previous ocular surgery, and use of corticosteroids were also recorded. Results: Of the 625 patients, 68.2% were male and 31.8% were female. The age group affected most was the sixth decade; 21.9% (137 cases). Trauma was the most common associated risk factor in 151 cases (24.2%) followed by previous ocular surgery in 111 (17.8%). Out of the 625 corneal scrapings, 393 (62.9%) were culture-positive. Bacterial culture accounted for 60.6% (238/393) and fungal cultures were 143 (36.4%). More than 50% of the bacterial keratitis cases and more than 60% of the fungal cases had a favorable outcome. Staphylococcus sp. and Fusarium sp. were the most common bacteria and fungus isolated, respectively. Only one-third of the cases required surgical intervention, and the remaining two-thirds were managed medically. Conclusions: In the current study, cultures were positive in 63% of cases, and the majority of cases had bacterial growth. Surgical intervention was needed in one-third of the cases. Management of corneal infections is incomplete without a good microbiological workup. Ophthalmologists should be encouraged to learn and practice basic staining procedures, and this should start early in the training years.

Retrospective view on fungal and bacterial profile in the suspected cases of keratitis

“…showed among bacteria's Staphylococcus was major gram-positive organism isolated followed by Streptococcus, which was the common pattern of growth seen all over India as well in our study. [11][12][13][14] In our study we found 47.7% of organism were gram positive cocci, study conducted by Gopinathan [15][16][17] In the present study majority of the Fungus isolated were like Aspergillus and Fusarium, it was observed that a study conducted by Lin CC et al showed prevalence of Aspergillus and Fusarium were common among southern region of India due to hot and windy climate. 18…”

Comment on the Article

“…Out of these 157 patients, 112 (71.34%) were male and 45 (28.66%) were female, and the average age of the patients undergoing TPK was 54.01 years (range, 12–85 years). As already mentioned in the article, 1 corneal button culture yielded bacterial growth in 66 cases (42.04%) and fungal growth in 47 cases (29.94%), and 44 cases (34.65%) yielded no growth.…”

“…This communication is a continuation of the article titled “Delhi infectious keratitis study: Update on clinico-microbiological profile and outcomes of infectious keratitis” published in the previous edition of your Journal. 1 In the aforementioned article, 1 we had presented the microbiological profile of infectious keratitis along with the antimicrobial sensitivity pattern, and we would like to provide supplemental information about the 157 patients in the study who underwent therapeutic penetrating keratoplasty (TPK), with regard to their anatomical and visual outcomes postsurgery. Out of these 157 patients, 112 (71.34%) were male and 45 (28.66%) were female, and the average age of the patients undergoing TPK was 54.01 years (range, 12–85 years).…”

Infectious Keratitis: An Update on Role of Epigenetics

“…Bacterial keratitis is the commonest form of infectious keratitis globally with incidence ranging from 50 to 60% ( 29 ). The potential risk factors for bacterial keratitis include contact lenses, aqueous tear deficiencies, trauma, decreased immunologic defenses, eyelid alterations or malposition, neurotrophic keratopathy, topical corticoid medications and surgery ( 30 ).…”

“…Incidence of HSV (Viral keratitis) and Acanthamoeba keratitis are 15-40% and 0-5% respectively ( 32 ). Also, mixed infections comprising of infliction by more than one organism is also seen in 2-15% of patients ( 29 ).…”