Patterns of severe microbial keratitis requiring hospital admission: the Manchester experience

Session Details

Session Title: Cornea Medical II

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 08:00

Venue: Hall C3

First Author: : N.Chaudhry UK

Co Author(s): :    A. Hamilton   L. Au   A. Brahma   F. Carley           

Abstract Details

Purpose:

The purpose of the study was to analyze the trends of microbial keratitis in patients who were admitted to Manchester Royal Eye Hospital, evaluate the predisposing factors, microbial profile, antibiotic susceptibility and to look at the efficacy of primary monotherapy with a fluoroquinolone.

Setting:

Patients with severe microbial keratitis admitted to the eye ward at Manchester Royal Eye Hospital over a 12-month period between November 2013 and November 2014.

Methods:

Prospective data was collected for 56 patients during the study period on an excel database as patients were admitted to the ward. These patients underwent corneal scrapes with culture sensitivity (54/56), viral swabs (45/56), anterior segment photographs (44/56) and confocal microscopy (4/56) as a part of their management. They were treated empirically with fluoroquinolone monotherapy and ongoing treatment was adjusted according to microbial sensitivity and clinical response.

Results:

56 patients with age ranging from 22 to 96 years (mean: 58.6+/-20.4 years) were admitted for a period of 2 to 34 days (mean: 10+/-6.6 days). Corneal scrapes were positive in 27/54 patients. Commonly identified organisms were Staphylococcus aureus (n=7), Moraxella (n=6) Herpes Simplex Virus (n=5) and Pseudomonas (n=4). Fluoroquinolone monotherapy was used as primary treatment in 83%, which was modified in 6% based on microbial profile. Tectonic grafts were required for 4 patients; amniotic membrane transplantation and corneal glue for 2 patients each; three underwent temporary tarsorraphy; one aphakic patient required AC tap and intravitreal antibiotics; one underwent evisceration.

Conclusions:

Severe microbial keratitis with impending corneal perforation often necessitates hospital admission. In addition to the usual culprits like S. aureus and Pseudomonas, Moraxella keratitis was commonly seen and was increasingly present in contact lens wearers and trauma cases but also responded well to fluoroquinolones. Monotherapy with fluoroquinolones still remains an effective first-line treatment against a variety of organisms in the UK. In 5 patients antibiotics were changed due to severe keratitis requiring dual antibiotic therapy or due to multiple pathogens identified. Around a quarter of these patients with severe microbial keratitis required surgical intervention ranging from tectonic grafts to evisceration.

Financial Disclosure:

NONE