Pathogens and Antibiotic Susceptibilities of Global Bacterial Keratitis: A Meta-Analysis

Abstract

Bacterial keratitis (BK) is the most common type of infectious keratitis. The spectrum of pathogenic bacteria and their susceptibility to antibiotics varied with the different regions. A meta-analysis was conducted to review the global culture rate, distribution, current trends, and drug susceptibility of isolates from BK over the past 20 years (2000–2020). Four databases were searched, and published date was limited between 2000 and 2020. Main key words were “bacterial keratitis”, “culture results” and “drug resistance”. Forty-two studies from twenty-one countries (35 cities) were included for meta-analysis. The overall positive culture rate was 47% (95%CI, 42–52%). Gram-positive cocci were the major type of bacteria (62%), followed by Gram-negative bacilli (30%), Gram-positive bacilli (5%), and Gram-negative cocci (5%). Staphylococcus spp. (41.4%), Pseudomonas spp. (17.0%), Streptococcus spp. (13.1%), Corynebacterium spp. (6.6%) and Moraxella spp. (4.1%) were the most common bacterial organism. The antibiotic resistance pattern analysis revealed that most Gram-positive cocci were susceptive to aminoglycoside (86%), followed by fluoroquinolone (81%) and cephalosporin (79%). Gram-negative bacilli were most sensitive to cephalosporin (96%) and fluoroquinolones (96%), followed by aminoglycoside (92%). In Gram-positive cocci, the susceptibility trends of fluoroquinolones were decreasing since 2010. Clinics should pay attention to the changing trends of pathogen distribution and their drug resistance pattern and should diagnose and choose sensitive antibiotics based on local data.

Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns

“…Our study indicated that gram-negative bacteria preserve better susceptibility to the tested antibiotics compared with gram-positive bacteria, supporting evidence from previous reports [16,36,41,44,45,49]. The susceptibility of gram-negative bacteria to tested antibiotics seemed stable and maintained 90% over 15 years [7,16,19,41,45]. Most gram-negative isolates were susceptible to fluoroquinolone (96.3%) and cephalosporin (95.8%), followed by aminoglycoside (92.5%) in the present study.…”

“…The development of antimicrobial resistance is multifactorial, including injudicious use of antimicrobial agents, genetic mutational resistance and horizontal gene transfer of microorganisms per se [53]. Several recent studies have demonstrated the emergence of antibiotic resistance in ocular infections [16,19,41,42,45,49,50]. A certain proportion of antimicrobial-resistant bacteria among the isolated strains appeared annually in our study.…”

“…Many published studies have dedicated to comprehensive global data analyses of microbial keratitis [13,19,20]. However, the microbial spectrum and resistance patterns change greatly over time and vary enormously from region to region [19]. The establishment of updated local data of IK is essential to guide clinical practice.…”

Potential new fluoroquinolone treatments for suspected bacterial keratitis

“…In a recent meta-analysis of 38 studies, the most common isolates worldwide were Staphylococcus spp (including Staphylococcus aureus and coagulase-negative Staphylococci) (41.4%, 95% confidence limits 36.2%-46.7%), Pseudomonas spp (17.0%, 13.9%-20.7%), Streptococcus spp (13.1%, 10.9%-15.7%), Corynebacterium spp (6.6%, 5.3%-8.3%) and Moraxella spp (4.1%, 3.1%-5.4%). 15 Streptococcus pneumoniae and Nocardia spp are more frequently reported in series from South India, [16][17][18] whereas in North Europe, Nocardia spp are rarely isolated (0.01%). [19][20][21] The introduction of new surgical procedures may modify the profile of isolates, for example, the outbreaks of keratitis from Mycobacterium chelonae (M. chelonae), M. fortuitum and M. abscessus associated with contamination of the surgical field with non-sterile water during laser refractive surgery.…”

Research Progress and Potential Applications of Spermidine in Ocular Diseases

“…Staphylococcus aureus ( S. aureus ) is a leading cause of bacterial keratitis, which is associated with severe inflammation, serious ocular damage, and permanent vision loss [ 70 ]. Clinically, the most effective treatment is broad-spectrum antibiotics.…”