Laboratory Results, Epidemiologic Features, and Outcome Analyses of Microbial Keratitis: A 15-Year Review From St. Louis.
Academic Medical Centers
/ trends
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Bacteria
/ isolation & purification
Clinical Laboratory Techniques
Corneal Ulcer
/ drug therapy
Eye Infections, Bacterial
/ drug therapy
Eye Infections, Fungal
/ drug therapy
Female
Follow-Up Studies
Fungi
/ isolation & purification
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Missouri
/ epidemiology
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Visual Acuity
/ physiology
Journal
American journal of ophthalmology
ISSN: 1879-1891
Titre abrégé: Am J Ophthalmol
Pays: United States
ID NLM: 0370500
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
26
04
2018
revised:
23
09
2018
accepted:
26
09
2018
pubmed:
12
10
2018
medline:
22
11
2019
entrez:
12
10
2018
Statut:
ppublish
Résumé
To evaluate the laboratory results and prognostic factors of poor clinical outcomes in microbial keratitis cases over 15 years at Saint Louis University. Retrospective cohort and trend study. Microbiological and clinical information from culture-positive cases seen at Saint Louis University from 1999 to 2013 were reviewed retrospectively. Statistical analyses were used to determine microbiological and antibiotic susceptibility trends. Prognostic factors of poor clinical outcome from the literature were used to create multivariate regression models to describe our cohort. Gram-positive organisms predominated (48%), followed by gram-negative organisms (34%) and fungi (16%). The most commonly isolated organism was Pseudomonas aeruginosa (21%). Oxacillin-resistant rates of Staphylococcus aureus and coagulase-negative staphylococci were 45% and 43%, respectively. Only the proportion of Pseudomonas changed significantly over time (P = .02). The only antibiotic found to lose efficacy over time was gentamicin for gram-positive organisms (P = .005). Multivariate logistic regression analyses revealed that major complications were associated with large ulcers (P < .006), fungal cases (P < .001), and comorbid ophthalmic conditions (P < .001). Poor healing was associated with large ulcers (P < .001) and fungal cases (P < .001). Lastly, poor visual outcome was associated with large ulcers (P < .01) and age ≥ 60 years (P < .02). In the St Louis area, oxacillin-resistant organisms, Pseudomonas aeruginosa, and fungi are commonly recovered from microbial keratitis cases with a disproportionally high incidence. Hence, empiric antibiotic choice should reflect these trends. Special care needs to be taken for patients with large ulcers and fungal infections, as well as elderly patients with comorbid ophthalmic conditions, as these patients have worse clinical outcomes.
Identifiants
pubmed: 30308206
pii: S0002-9394(18)30574-9
doi: 10.1016/j.ajo.2018.09.032
pmc: PMC6349514
mid: NIHMS1509150
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-62Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001881
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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