Empirical treatment of bacterial keratitis: an international survey of corneal specialists

Austin, Ariana; Schallhorn, Julie M.; Geske, Mike; Mannis, Mark J.; Lietman, Tom; Rose‐Nussbaumer, Jennifer

doi:10.1136/bmjophth-2016-000047

Cited by 44 publications

(36 citation statements)

References 15 publications

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“…Indeed, a recent international survey of cornea specialists found that concerns over several of these factors were predictive of antibiotic choice. 29 …”

Section: Bacterial Keratitismentioning

confidence: 99%

Update on the Management of Infectious Keratitis

2017

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Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and while culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungal keratitis and Acanthameoba. Next generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However outcomes remain poor secondary to corneal melting, scarring and perforation. Adjuvant therapies aimed at reducing the immune response responsible for much of the morbidity associated with keratitis include topical corticosteroids. The large, randomized controlled Steroids for Corneal Ulcers trial found that while steroids provided no significant improvement overall, they did appear beneficial for ulcers that were central, deep or large, non-Nocardia or classically invasive P. aeruginosa, patients with low baseline vision, and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960’s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial showed a benefit of topical natamycin over topical voriconazole for fungal keratitis, particularly among those caused by Fusarium. The second Mycotic Ulcer Treatment Trial showed that oral voriconazole did not improve outcomes overall although there may have been some effect among Fusarium ulcers. Given an increase in non-serious adverse events the authors concluded that they could not recommend oral voriconazole at this time. Viral keratitis differs from bacterial and fungal cases in that is often recurrent and is common in developed countries. The first Herpetic Eye Disease Study (HEDS) showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of HSV keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.

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“…Indeed, a recent international survey of cornea specialists found that concerns over several of these factors were predictive of antibiotic choice. 29 …”

Section: Bacterial Keratitismentioning

confidence: 99%

Update on the Management of Infectious Keratitis

2017

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“…This ulceration of the cornea can result in a penetrating wound and lead to endophthalmitis [ 88 ]. Current treatment of bacterial keratitis consists of topical broad spectrum antibiotics [ 87 , 89 ]; however, antibiotics alone may not be the most effective treatment since the pathogenesis during pneumococcal keratitis is not from bacterial burden alone [ 90 ].…”

Section: Infectious Diseasesmentioning

confidence: 99%

The Role of Pneumococcal Virulence Factors in Ocular Infectious Diseases

Benton

Marquart

2018

Interdisciplinary Perspectives on Infectious Diseases

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Streptococcus pneumoniae is a gram-positive, facultatively anaerobic pathogen that can cause severe infections such as pneumonia, meningitis, septicemia, and middle ear infections. It is also one of the top pathogens contributing to bacterial keratitis and conjunctivitis. Though two pneumococcal vaccines exist for the prevention of nonocular diseases, they do little to fully prevent ocular infections. This pathogen has several virulence factors that wreak havoc on the conjunctiva, cornea, and intraocular system. Polysaccharide capsule aids in the evasion of host complement system. Pneumolysin (PLY) is a cholesterol-dependent cytolysin that acts as pore-forming toxin. Neuraminidases assist in adherence and colonization by exposing cell surface receptors to the pneumococcus. Zinc metalloproteinases contribute to evasion of the immune system and disease severity. The main purpose of this review is to consolidate the multiple studies that have been conducted on several pneumococcal virulence factors and the role each plays in conjunctivitis, keratitis, and endophthalmitis.

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“…Microbial keratitis is a major cause of corneal opacity and loss of vision worldwide, and topical antimicrobial therapy is a critical component in its management. The study by Austin et al 1 found that there are regional variations in practice patterns influenced by concern over availability and toxicity versus broad-spectrum coverage and resistance. Respondents in the USA were more likely to treat with fortified antibiotics than their international peers.…”

mentioning

confidence: 99%

“…Respondents in the USA were more likely to treat with fortified antibiotics than their international peers. 1 …”

mentioning

confidence: 99%