Predictive factors for response to medical therapy in bacterial ulcerative keratitis

Kim, Rosa Y.; Cooper, Kevin; Kelly, Lisa D.

doi:10.1007/bf00189353

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…In addition, ocular susceptibility to fungal infections is increased and fungal organisms have been shown to behave more aggressively after topical administration of corticosteroids (Pappa 1994;Brooks 1999). Other retrospective studies have identified topical corticosteroids as a predictor of poor outcome for infectious ulcerative keratitis in humans (Pappa 1994;Kim et al 1996;Wong et al 2003). These findings support the hypothesis that topical corticosteroids may allow increased bacterial colonisation, proliferation and the potential for increased virulence.…”

Section: Discussionsupporting

confidence: 60%

Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993-2004)

Keller

Hendrix

2010

Equine Veterinary Journal

120

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Summary Reasons for performing study: Bacterial ulcerative keratitis is a common and often vision‐threatening problem in horses. Emerging bacterial resistance to commonly used topical antibiotics has been demonstrated. Previous antibiotic use may alter the antimicrobial susceptibility of bacterial isolates. Objectives: To document aerobic bacterial isolates and associated bacterial susceptibilities from horses with ulcerative keratitis treated at the University of Tennessee between January 1993 and May 2004 and determine whether prior antibiotic therapy affected antimicrobial susceptibility of the isolates. Methods: Medical records from horses with ulcerative keratitis and positive aerobic bacterial cultures and antimicrobial susceptibility were evaluated. Clinical history regarding antibiotic therapy prior to culture was documented. Results: Fifty‐one aerobic bacterial isolates from 43 horses were identified. Streptococcus equi subspecies zooepidemicus was the most commonly isolated organism, accounting for 33.3% of all isolates, followed by Pseudomonas aeruginosa (11.8%), Staphylococcus spp. (11.8%) and Gram‐negative nonfermenting rods (7.8%). No resistance was noted amongst S. equi ssp. zooepidemicus to cephalothin, chloramphenicol or ciprofloxacin. Only 64% of S. equi ssp. zooepidemicus isolates were sensitive to bacitracin. No resistance was noted among P. aeruginosa to gentamicin, tobramycin or ciprofloxacin. Antibiotic therapy with neomycin‐polymixin B‐bacitracin prior to presentation and culture was documented in 11/17 horses in which S. equi ssp. zooepidemicus was isolated and in 4/6 horses in which P. aeruginosa was isolated. Three horses received topical corticosteroids prior to culture, of which 2 had polymicrobial infections. Conclusions: S. equi ssp. zooepidemicus and P. aeruginosa were the most frequently isolated bacterial organisms in equine ulcerative keratitis. No significant trends in aminoglycoside or fluoroquinolone resistance were noted among these organisms. However, the resistance of S. equi ssp. zooepidemicus to bacitracin with common use of this antibiotic suggests that previous antibiotic therapy probably affects antimicrobial resistance. Potential relevance: Therapy prior to culture may play an important role in antimicrobial susceptibility of corneal bacterial isolates. Corticosteroid use may increase the risk of polymicrobial infections of corneal ulcers, leading to a worse prognosis. Although significant fluoroquinolone resistance has not been documented in the veterinary literature, these antimicrobials should be reserved for known infected corneal ulcers and not used for prophylaxis. Empirical antibiotic therapy should not only be guided by clinical signs, but also take into consideration previous antimicrobial and corticosteroid therapy.

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Section: Discussionsupporting

confidence: 60%

Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993-2004)

Keller

Hendrix

2010

Equine Veterinary Journal

120

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“…While epidemiologically useful, large studies have not shown a relation between antibiotic resistance and clinical outcomes [23,24]. This is not surprising as ophthalmic antibiotic preparations are applied topically at concentrations as high as three orders of magnitude greater than typical minimum inhibitory concentrations with resulting high corneal concentrations.…”

Section: Discussionmentioning

confidence: 99%

Microbial Keratitis at an Urban Public Hospital: A 10-Year Update

Truong

Bui

Memon

et al. 2015

J Clin Exp Ophthalmol

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Purpose To review the epidemiology, risk factors, microbiologic spectrum, and treatment of microbial keratitis during a five-year period at an urban public hospital with comparison to similar findings a decade earlier at the same hospital. Methods Retrospective chart review in the 5-year interval 2009 through 2014 compared to previously reported cases 2000 through 2004 [Eye & Contact Lens 33(1): 45-49, 2007]. Comparative primary outcome measures included best-corrected visual acuity (BCVA), risk factors, culture and sensitivities, treatment, and complication rates. Results 318 eyes with microbial keratitis were identified. Contact lens wear, ocular trauma, and ocular surface diseases were the most common risk factors. The culture and recovery rates were 73% and 66% respectively. Gram-positive organisms represented 46%, gram-negative organisms 39%, fungal organisms 15%, and Acanthamoeba <1% of corneal isolates. No common corneal pathogens were resistant to aminoglycosides or vancomycin. 48% of cases were initially treated with fortified antibiotics, 43% with fluoroquinolone monotherapy, and 6% with antifungals. 40% of cases received inpatient treatment. At resolution, average BCVA was 20/82 [logMAR 0.61] with 8% of cases resulting in light perception or worse vision. The perforation rate was 8%. 6% of cases underwent urgent penetrating keratoplasty and 4% of cases underwent urgent enucleation or evisceration. Compared to the prior study, significant differences were: (1) lower culture but higher recovery rates, (2) lower admission rate, (3) more contact lens-related cases of Pseudomonas ulcers, (4) lower resistance of coagulase-negative Staphylococcus to aminoglycoside antibiotics, (5) improved BCVA at resolution, and (6) lower associated complication rates. Conclusion Microbial keratitis remains a clinical challenge in the urban public hospital setting. In the past ten years, epidemiology has shifted towards greater contact lens wear with more Pseudomonal infections. Visual outcomes have not worsened despite a shift away from routine culture and inpatient care to fluoroquinolone monotherapy and outpatient management.

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“…4,58 Retrospective studies of bacterial keratitis have not shown a correlation between susceptibility and the effects of initial antibacterial therapy. 30,[59][60][61] Interpreting these reports is limited by use of multiple antimicrobial agents and potential confounding by clinical severity. Relating antimicrobial susceptibility with outcome would help to establish evidence-based practice recommendations in ophthalmology.…”

Section: Commentmentioning

confidence: 99%

Influence of Fluoroquinolone Susceptibility on the Therapeutic Response of Fluoroquinolone-Treated Bacterial Keratitis

Wilhelmus¹

2003

Arch Ophthalmol

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To estimate how a corneal isolate's minimal inhibitory concentration for a fluoroquinolone agent affects the rate of clinical response of bacterial keratitis to fluoroquinolone therapy. Design: Prospective cohort study. Methods: Six hundred sixty-three individuals with suspected bacterial keratitis underwent diagnostic corneal scraping and were treated with topical 0.3% ciprofloxacin solution or ointment. Of 407 patients with cultureconfirmed bacterial keratitis, improvement and cure rates with ciprofloxacin monotherapy were estimated for 391 who had in vitro ciprofloxacin susceptibility of the principal corneal isolate. Main Outcome Measures: Slitlamp biomicroscopic assessment for clinical improvement of corneal inflammation and for clinical cure with complete reepithelialization. Results: Adjusted rates of improvement and of cure were reduced, respectively, by 43% (95% confidence limits, 8%, 64%) and by 29% (95% confidence limits, 0%, 49%) among corneal infections having a ciprofloxacin minimal inhibitory concentration above 1.0 µg/mL compared with those with more sensitive isolates. Conclusions: Corneal infection by relatively ciprofloxacin-resistant bacteria responds more slowly to ciprofloxacin therapy. Antibacterial susceptibility testing of corneal cultures may predict the fluoroquinolone therapeutic response rate of bacterial keratitis.

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Predictive factors for response to medical therapy in bacterial ulcerative keratitis

Abstract: In this population, ulcer size at the onset of antibacterial treatment and the use of certain ocular medications, specifically corticosteroids, were significant predictive factors for failure of medical therapy for BUK.

Cited by 17 publications

References 23 publications

Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993-2004)

Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993-2004)

Microbial Keratitis at an Urban Public Hospital: A 10-Year Update

Influence of Fluoroquinolone Susceptibility on the Therapeutic Response of Fluoroquinolone-Treated Bacterial Keratitis

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