Trends in the Microbiological Spectrum of Nonviral Keratitis at a Single Tertiary Care Ophthalmic Hospital in India: A Review of 30 years

Abstract

Purpose:The aims of this study were to assess the trends in microorganisms from patients with infectious keratitis and to assess their antibiogram patterns at a tertiary eye care center in India. Methods:In this retrospective observational case series, microbiological records of all corneal ulcers were reviewed from 1991 to 2020 and assessed for trends in keratitis and antibiotic susceptibility using the x 2 test.Results: Of the total of 51,747 patients, 51.13% were culture positive. A decrease in bacteria was noted from 56% to 38%, with a parallel increase in fungal isolates from 24% to 51%. Gram-positive bacteria accounted for 70.8% of the total bacteria, a trend in rise of Streptococcus pneumoniae (31%) and a decreasing trend in prevalence of Staphylococcus epidermidis was observed over 30 years. Pseudomonas aeruginosa (55.5%) was the most prevalent gramnegative pathogen, whereas Fusarium spp. (33.1%) and Aspergillus spp. (32.4%) were the most common fungal isolates. The susceptibility of gram-positive organisms to cefazolin decreased from 95.5% to 66% (P = 0.0001), amikacin from 88% to 55% (P= 0.0001), and vancomycin from 98.9% to 90.7% (P , 0.05). A similar decrease in susceptibility was also significant for gram-negative organisms with piperacillin/tazobactam and chloramphenicol (P , 0.05). A significant trend toward increasing resistance against fluoroquinolones was also observed for ciprofloxacin (gram-positive organisms: 16% to 50%; gram-negative organisms: 11.5% to 18.7%), gatifloxacin (38% to 47%), and moxifloxacin (9.4% to 29%). Conclusions:The spectrum of keratitis has changed, and fungus is now the predominant etiology. An increasing trend in resistance to all antibiotics studied would affect the empiric treatment, also suggesting regular surveillance.

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis

“…Notably, a recent multistate outbreak associated with drug-resistant Pseudomonas aeruginosa linked to artificial tears eye drops resulted in severe cases of keratitis, panophthalmitis, vision loss, and even enucleation and death [ 57 , 58 , 59 , 60 ]. Globally, reports have indicated a rising trend in resistance to fluoroquinolones and ceftazidime [ 61 , 62 , 63 ]. There were also differences in the minimum inhibitory concentrations (MIC90s) among fluoroquinolones, with consistently lower levels found with newer-generation fluoroquinolones, such as besifloxacin [ 48 ].…”

Die Fusarien-Keratitis auf dem Vormarsch – eine aktuelle klinische Übersicht

“…0.03 per 100,000) and the highest rate in South Asia (73 per 100,000) [8,9]. Worldwide, a steady increase in the mycotic proportion of infectious keratitis can be observed (up to 5.8 % annually), especially in developing and emerging countries [1,10] (cf. ▶ Table 1).…”

“…0,03 pro 100 000) und der höchsten Rate in Südasien (73 pro 100 000) [8,9]. Weltweit ist dabei unter den infektiösen Keratitiden eine stetige Zunahme des mykotischen Anteils zu beobachten (bis zu 5,8 % jährlich), insbesondere in Entwicklungs-und Schwellenländern [1,10] (vgl. ▶ Tab.…”

The activity of antimicrobial peptoids against multidrug-resistant ocular pathogens

“…[ 9 ] Many of these microbes are becoming increasingly resistant to available antimicrobials. Ocular isolates of P. aeruginosa have had increased resistance to macrolides and β-lactams for over 30 years during an observation period from 1991 to 2020 [ 10 ]. The isolation of methicillin-resistant S. aureus from the eye is increasing in occurrence, and often, these strains are also resistant to other commonly prescribed antibiotics [ 11 ].…”