RESUMO
Purpose: This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics. Methods: The microbiology laboratory records of 228 patients with culture?proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi?squared or Fisher’s exact test were applied to check the significance of difference between the susceptibility levels of antibiotics. Results: The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa–induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034). Conclusion: Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram?positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.
RESUMO
Purpose: To differentiate Pythium keratitis from fungal keratitis using clinical signs, to explore usefulness of various signs as diagnostic prognosticators, and develop a clinical scoring system. Methods: A retrospective review of medical records and archived clinical photographs of patients with culture?positive Pythium keratitis and hyaline filamentous fungal keratitis was conducted at a tertiary eye institute to explore characteristics of ulcers that may aid diagnosis. Results: Full?thickness corneal stromal keratitis (P = 0.055), a dry ulcer surface (P = 0.010), tentacles (P < 0.0001), intrastromal dots (P < 0.0001), ring infiltrates (P = 0.024), reticular patterns (P < 0.0001), and peripheral furrows (P < 0.0001) were clinical signs associated with Pythium keratitis. Multiple regression analysis identified tentacles (odds ratio: 24.1, 95% confidence interval (CI): 3.8–158.1, P = 0.001) and peripheral furrows (odds ratio: 60.6, 95% CI: 5.1–712.3, P = 0.001) as independent diagnostic prognosticators for Pythium keratitis. The positive and negative likelihood ratios of a dry ulcer surface, tentacles, intrastromal dots, ring infiltrates, reticular patterns, and peripheral furrows predicting Pythium keratitis were 1.6, 13.6, 17.9, 4.3, 30.7, 15.3 and 0.4, 0.4, 0.7, 0.9, 0.6 and 0.8, respectively. The presence of two or more of these clinical signs (excluding a dry ulcer surface) had a sensitivity of 55.6% and a false positive rate of 1.4%. Conclusion: Tentacles, intrastromal dots, ring infiltrates, reticular patterns, and peripheral furrows are clinical signs to be considered for the diagnosis of Pythium keratitis and the presence of two or more signs has a very low false positive rate