Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital
| Autor: | J Gisseman, Zaina Al-Mohtaseb, Nathan Law, Cameron Clarke, Li Wang, Walter T Parker, Haoxing Jin, Stephen C. Pflugfelder |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Adult Hospitals County Male medicine.medical_specialty Adolescent medicine.drug_class Antibiotic sensitivity Antibiotics Microbial Sensitivity Tests Eye Infections Bacterial Keratitis 03 medical and health sciences Cellular and Molecular Neuroscience Young Adult 0302 clinical medicine Antibiotic resistance Risk Factors Internal medicine Drug Resistance Bacterial medicine Tobramycin Humans Child Aged Retrospective Studies Aged 80 and over business.industry Incidence Middle Aged medicine.disease Prognosis Texas Sensory Systems Surgery Anti-Bacterial Agents Contact lens Ophthalmology 030104 developmental biology 030221 ophthalmology & optometry Vancomycin Population study Female business Hospitals High-Volume medicine.drug Follow-Up Studies |
| Zdroj: | The British journal of ophthalmology. 101(11) |
| ISSN: | 1468-2079 |
| Popis: | Purpose: To identify the risk factors, causative organisms, antimicrobial susceptibility and outcomes of microbial keratitis in a large county hospital in Houston, Texas. Design: Case series. Methods Setting: A large county hospital in Houston, Texas. Study Population: Patients with known diagnosis of microbial keratitis from January 2011 to May 2015. Observation Procedure: Retrospective chart review. Main Outcomes: Epidemiology, risk factors, outcomes and antibiotic susceptibility of microbial keratitis. Results The most commonly identified risk factors were contact lens use (34.4%), ocular trauma (26.3%), diabetes mellitus (16.7%), ocular surgery (13.5%), ocular surface diseases (11.5%), previous keratitis (10.4%), glaucoma (6.3%), cocaine use (5.2%) and HIV-positive status (4.2%). Eyes with positive cultures (61.5%) were associated with worse visual outcomes (p=0.019) and a higher number of follow-up visits (p=0.007) than eyes with negative cultures (38.5%). Corneal perforation was the most common complication (11.5%). Gram-negative organisms (21.9%) were all susceptible to ceftazidime, tobramycin and fluoroquinolones. Gram-positive organisms (33.3%) had worse outcomes than Gram-negative organisms (21.9%) and exhibited a wide spectrum of antibiotic resistance, but all were susceptible to vancomycin. Twenty-seven per cent of the coagulase-negative Staphylococci were resistant to fluoroquinolones. Conclusion This study identified a recent shift in risk factors and antibiotic resistance patterns in microbial keratitis at a County Hospital in Houston, Texas. In our patient population, fluoroquinolone monotherapy is not recommended for severe corneal ulcers. On the basis of these results, vancomycin and tobramycin should be used for empirical therapy until microbial identity and sensitivity results are available. |
| Databáze: | OpenAIRE |
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