Infectious keratitis in southern Brazil: a comparison culture negative and culture positive patients / Ceratite infecciosa no sul do Brasil: comparação entre pacientes com cultura negativa e positiva

Abstract Purpose: To compare clinical-epidemiological profile and treatment outcome between culture negative and culture positive keratitis patients. Methods: Patients with suspected infectious keratitis seen at two ophthalmic hospitals in Curitiba, Brazil, between June 2014 and April 2016, were prospectively studied. Ophthalmological exam with corneal scraping and microbiological tests were performed. Data regarding follow up, surgical interventions and treatment outcome were collected after 12 weeks of the first visit trough medical chart review. From the results of the culture, two groups were formed: culture negative keratitis (CNK) and culture positive keratitis (CPK). Results: According to inclusion criteria 21 patients were classified as culture negative keratitis and 20 patients as culture positive keratitis. The number of patients on antibiotic drops at the first visit was greater in CNK group (90.5% versus 60%; p=0.032). Surgical procedures were necessary in 3 patients (15%) in CNK group and in 7 patients (36,8%) in CPK group (p=0.155). Treatment success was achieved by 85% (17/20) of the patients in CNK group and by 61% (11/18) of the patients in CPK group (p=0.144). There was no significant difference between groups regarding age, gender, place of residence, presence of comorbidities, risk factors for infectious keratitis, duration of symptoms and characteristics of corneal ulcer. Conclusions: Previous treatment with antibiotics correlates with negative culture results. There was no significant difference in treatment outcome between culture negative and culture positive keratitis patients.

Resumo Objetivo: Comparar os perfis clinico-epidemiológicos e os desfechos entre pacientes com ceratite com cultura positiva e pacientes com ceratite com cultura negativa. Métodos: Pacientes com ceratite infecciosa, atendidos em dois hospitais oftalmológicos em Curitiba, Brasil, entre junho de 2014 e abril de 2016, foram estudados prospectivamente. Exame oftalmológico, raspado de córnea e exames microbiológicos foram realizados no primeiro atendimento. Os dados quanto a seguimento e desfecho foram coletados após 12 semanas do primeiro atendimento através de revisão de prontuário. A partir dos resultados das culturas, dois grupos foram formados: ceratite com cultura negativa e ceratite com cultura positiva. Resultados: Vinte e um pacientes foram classificados como ceratite com cultura negativa e 20 como ceratite com cultura positiva. O número de pacientes em uso de colírio antibiótico no primeiro atendimento foi maior no grupo de cultura negativa (90,5% versus 60%; p=0,032). Sete pacientes (37%) no grupo cultura positiva precisaram de procedimentos cirúrgicos no manejo da ceratite, versus 3 pacientes (15%) do grupo cultura negativa (p=0,155). Oitenta e cinco por cento (17/20) dos pacientes do grupo cultura negativa alcançaram sucesso no tratamento, contra 61% (11/18) dos pacientes no grupo cultura positiva (p=0,144). Não houve diferença entre os grupos quanto a idade, gênero, local de procedência, presença de comorbidades, fatores de risco, duração dos sintomas e características da úlcera de córnea. Conclusão: Tratamento prévio com colírio de antibiótico correlaciona-se com resultados negativos de cultura. Não houve diferença no desfecho após tratamento entre os pacientes com cultura negativa e cultura positiva.

Estudo epidemiológico das queratites infeciosas internadas num centro hospitalar terciário - revisão de 5 anos / Epidemiological study of infeccious keratitis in inpatients of a terciary hospital center - revision of 5 years

Resumo Objetivo: A queratite infeciosa é uma doença de incidência relativamente elevada e é responsável por um número importante de internamentos. Neste estudo pretende-se estudar diversas características epidemiológicas e clínicas associadas às queratites infeciosas de alto risco num hospital terciário em Portugal. Métodos: Realizou-se um estudo retrospetivo, onde foram incluídos todos os doentes internados por abcesso da córnea no Centro Hospitalar Universitário do Porto (CHUP), entre Abril de 2013 a Março de 2018. Caracterizou-se a população em relação aos fatores de risco, apresentação clínica, tempo de internamento, resultados de culturas, resistência antibiótica in vitro, tratamento efetuado e resultado funcional. Resultados: O estudo incluiu 105 doentes. Os principais fatores de risco foram antecedentes de cirurgia de córnea, uso de lentes de contacto e história recente de trauma ocular. 74,3% dos doentes tiveram cultura positiva com 87,9% a corresponderem a cultura bacteriana pura, sendo a Pseudomonas aeruginosa e o Streptococcus pneumoniae os agentes etiológicos mais frequentes. 27,9% das culturas positivas eram resistentes a 3 ou mais classes de antibióticos. Todos os doentes iniciaram tratamento com colírios fortificados. 29,5% dos doentes necessitaram de realizar transplante de córnea. Ao final de 6 meses de seguimento, apenas 20,9% apresentavam AV>20/40. Conclusão: Na maioria dos casos, a etiologia foi bacteriana. Observou-se um número considerável de bactérias multirresistentes. Apesar do tratamento ter permitido uma melhoria da visão na maioria dos casos, um número considerável de doentes ficou com sequelas visuais importantes.

Abstract Objective: Infectious keratitis is a pathology with a high incidence and is responsible for a large number of prolonged stay hospital admissions. The purpose was to analyze the epidemiological and clinical data associated with high risk microbial keratitis at a central hospital in Portugal. Methods: A retrospective study of all inpatients presenting with corneal abscess in Centro Hospitalar Universitário do Porto, from April 2013 to March 2018 was performed. Target population was characterized by risk factors, clinical features, length of stay, culture results, in vitro antibiotic resistance, treatment and outcome. Results: This study included 105 patients. The main risk factors were previous corneal surgery, contact lenses wear and recent history of ocular trauma. 74.3% of patients had a positive culture, 87.9% of these corresponding to a pure bacterial culture, with Pseudomonas aeruginosa and Streptococcus pneumoniae being the most common pathogens. 27.9% of positive cultures were resistant to 3 or more classes of antibiotics. All patients began treatment with fortified drops. 29.5% of patients required a corneal transplant. After 6 months of follow-up, only 20.9% presented a VA>20/40. Conclusion: Most cases were caused by bacteria. A considerable number of multi-resistant bacteria was identified. Despite most cases having improved after treatment, a large number of patients had a significant visual acuity sequelae.

Microbiological and epidemiological study of infectious keratitis in children and adolescents / Estudo microbiológico e epidemiológico da ceratite infecciosa em crianças e adolescentes

ABSTRACT Purpose: To analyze epidemiological and microbiological aspects of microbial keratitis in children and adolescents. Methods: This retrospective cohort study was conducted at the Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, between July 15, 1975, and December 31, 2010. We analyzed corneal samples from 859 patients with clinical suspicion of infectious keratitis, comparing epidemiological and microbiological characteristics of bacterial keratitis with those of non-bacterial and non-viral keratitis. We also compared Gram-positive and Gram-negative pathogens in patients with bacterial keratitis. We created a susceptibility profile of the bacterial microorganisms studied. Results: Of the 859 patients, 346 (40.3%) showed positive culture results for non-viral microorganisms. Teenagers (13-18 years) made up the group with the highest number of patients with keratitis (164, 47.4%). The most frequent risk factors for keratitis were trauma (33.5%) and previous ocular surgery (24.9%). Gram-positive bacteria (71.8%) were the most often isolated, with coagulase-negative Staphylococcus (23.8%) the most prevalent microorganism. Logistic regression analysis showed age (p=0.002), topical antimicrobial drug use (p=0.01), and trauma due to non-chemical burns (p=0.005) were risk factors for non-bacterial keratitis. Age (p=0.01) was also a risk factor for Gram-negative bacterial keratitis. Conclusion: Our study showed that in the age range studied, the prevalence of keratitis caused by Gram-negative bacteria or by the non-viral microorganisms evaluated increases with age. Previous use of topical antimicrobial drug and trauma due to non-chemical burns are associated with non-bacterial keratitis. Knowledge of the risk factors and the microorganisms involved may help improve treatment of keratitis in children and adolescents and minimize visual impairment.

RESUMO Objetivos: Descrever o perfil epidemiológico e microbiológico de ceratite microbiana em crianças e adolescentes. Métodos: Estudo retrospectivo tipo coorte, utilizando fichas laboratoriais de pacientes, atendidos no Departamento de Oftalmologia e Ciências Visuais - Escola Paulista de Medicina - Universidade Federal de São Paulo, entre 15 de julho de 1975 a 31 de dezembro de 2010. Foram comparados pacientes com ceratite bacteriana e não bacteriana (não viral). Entre os pacientes com ceratite bacteriana, foram comparados aqueles em que a ceratite foi causada por bactérias Gram positivas e Gram negativas. O perfil de sensibilidade dos microrganismos bacterianos aos antimicrobianos também foi estudado. Resultados: Foram analisadas amostras corneanas de 859 pacientes com suspeita clínica de ceratite infecciosa, na faixa etária estudada. Destes, 346 (40,3%) apresentaram resultados de culturas positivas para microrganismos não virais. Adolescentes (13 a 18 anos) compuseram o grupo com maior número de pacientes com ceratite (164-47,4%). Os principais fatores de risco foram trauma (33,5%) e cirurgias oculares prévias (24,9%). Bactérias Gram positivas foram isoladas com maior frequência (71,8%), sendo prevalente o patógeno Staphylococcus coagulase negativo (23,8%). De acordo com a análise de regressão logística, idade (p=0,002), uso tópico de drogas antimicrobianas (p=0,01) e trauma por queimadura não química (p=0,005) foram fatores predisponentes para ceratite não bacteriana. Idade (p=0,01) também foi fator de risco para ceratite causada por bactérias Gram negativas. Conclusões: Nosso estudo mostrou que quanto maior a idade, na faixa etária estudada, maior a probabilidade da ceratite ser causada por bactérias Gram negativas e/ou por outros microrganismos não virais avaliados. O uso tópico de drogas antimicrobianas prévias e trauma devido à queimadura não química predispõe à ceratite não bacteriana. O conhecimento dos fatores de risco e dos microrganismos envolvidos resultarão em tratamento específico da ceratite em crianças e adolescentes, com menores danos visuais.

Sensibilidad antibiótica de bacterias obtenidas de queratitis e infecciones intraoculares en la Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia / Antibiotic susceptibility patterns of bacteria isolated from keratitis and intraocular infections at Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia

Introducción. La resistencia bacteriana es crítica para la selección de los antibióticos en el tratamiento de las infecciones, por ello es vital conocer su estado actual en nuestro medio. Objetivo. Determinar la sensibilidad antibiótica bacteriana in vitro obtenida de los cultivos de queratitis e infecciones intraoculares. Materiales y métodos. Se llevó a cabo un estudio retrospectivo en la Fundación Oftalmológica de Santander (FOSCAL), entre junio de 2011 y enero de 2012. Resultados. Se examinaron 92 muestras. Se identificaron 110 bacterias, 27 hongos y 12 amebas de vida libre. Del total de bacterias Gram positivas, 1,1 %, 0 %, 1,1 %, 16,9 %, 29,3 % y 85 % fue resistente a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina, respectivamente, mientras que la resistencia a estos mismos fármacos se presentó, respectivamente, en 0 %, 8,3 %, 0 %, 0 %, 18,2 % y 27,3 % de las bacterias Gram negativas. Los porcentajes de resistencia de los estafilococos positivos para coagulasa resistentes a la meticilina fueron 0 %, 0 %, 0 %, 7 %, 17 % y 100 %, respectivamente, y los porcentajes de los estafilococos negativos para coagulasa resistentes a la meticilina fueron 3 %, 0 %, 0 %, 24 %, 44 % y 100 %, respectivamente. Los porcentajes de resistencia bacteriana globales (tanto para bacterias Gram positivas como para Gram negativas) a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina fueron 1 %, 1 %, 1 %, 15,1 %, 28 % y 64,5 %, respectivamente. Conclusiones. Los niveles de resistencia bacteriana para imipenem, moxifloxacina y gatifloxacina fueron menores que para levofloxacina, ciprofloxacina y tobramicina. Los niveles de resistencia para la tobramicina fueron muy altos, lo que pone en duda su utilidad clínica en las infecciones oculares en nuestro medio.

Introduction: Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. Objective: To determine in vitro antibiotic susceptibility of bacterial isolates obtained from keratitis and intraocular infections. Materials and methods: A retrospective study of microbiological tests in Fundación Oftalmológica de Santander (FOSCAL) was carried out between June, 2011, and January, 2012. Results: A total of 92 samples were examined and 110 bacteria, 27 fungi and 12 free-living amoebae were identified. Polymicrobial infections constituted 50% of the total; 1.1%, 0%, 1.1%, 16.9%, 29.3% and 85% of Gram-positive bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively, while 0%, 8.3%, 0%, 0%, 18.2% and 27.3% of Gram-negative bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively. For methicillin-resistant coagulase-positive staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 0%, 0%, 0%, 7%, 17% and 100%, respectively. For methicillin-resistant coagulase-negative staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 3%, 0%, 0%, 24%, 44% and 100%, respectively. Overall bacterial resistance to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, for both Gram-positive and Gram-negative, was 1%, 1%, 1%, 15.1%, 28% and 64.5%, respectively. Conclusions: The levels of bacterial resistance to imipenem, moxifloxacin and gatifloxacin were lower than for levofloxacin, ciprofloxacin and tobramycin. The levels of resistance to tobramycin were very high, which calls into question its usefulness in this region of our country.

Prevalence and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus in ocular infections / Prevalência e suscetibilidade antibiótica de Staphylococcus aureus resistente à meticilina em infecções oculares

PURPOSE: To study the prevalence of methicillin-resistant Staphylococcus aureus among S. aureus ocular infections in a tertiary health center in Brazil and compare antibiotic susceptibility patterns between MRSA and methicillin-susceptible S. aureus isolates. METHODS: Electronic records from the ocular microbiology laboratory of the Universidade Federal de São Paulo were retrospectively reviewed. During a 10-year period (between January 2000 and December 2009) all conjunctivitis, keratitis, and endophthalmitis cases with a positive culture for S. aureus were identified. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. RESULTS: Five hundred sixty-six S. aureus isolates were identified; of those, 56 (9.9%) were resistant to methicillin. Throughout the 10-year period, Staphylococcus aureus showed a significant increasing trend from 7.55% to 16.18% among overall S. aurues infections (p=0.001) and from 3.7% to 13.16% in conjunctivitis (p=0.001). Conversely, we did not observe the same trend among those with keratitis (p=0.38). Staphylococcus aureus isolates showed higher resistance rates to tobramycin, gentamicin, ciprofloxacin, gatifloxacin, and moxifloxacin when compared with S. aureus isolates (p< 0.001). All cases were susceptible to vancomycin. CONCLUSION: We observed an increasing trend in the overall prevalence of Staphylococcus aureus ocular infections and statistically significant higher resistance rates to commonly used antibiotics compared to Staphylococcus aureus. Our data supports the need for constant bacterial surveillance and should be taken into consideration before initiating empiric treatment of ocular infections.

OBJETIVO: Estudar a prevalência do Staphylococcus aureus resistente à meticilina nas infecções oculares causadas por S. aureus em um centro de saúde terciário no Brasil e comparar o perfil de suscetibilidade antimicrobiana entre as cepas de Staphylococcus aureus resistente à meticilina e S. aureus susceptível à meticilina MÉTODOS: Foi realizada uma análise retrospectiva dos arquivos do laboratório de microbiologia ocular da Universidade Federal de São Paulo e selecionados todos os casos de conjuntivite, ceratite e endoftalmite com cultivo positivo para S. aureus, durante um período de 10 anos (entre janeiro de 2000 e dezembro de 2009). Foi avaliada a prevalência de Staphylococcus aureus resistente à meticilina e comparado o perfil de susceptibilidade antimicrobiano dos Staphylococcus aureus resistente à meticilina e S. aureus susceptível à meticilina. RESULTADOS: Quinhentos e sessenta e seis isolados de S. aureus foram identificados. Desses, 56 (9,9%) apresentaram resistência à meticilina. Durante o período de 10 anos estudado, Staphylococcus aureus resistente à meticilina mostrou uma tendência significante de aumento de 7,6% para 16,2% entre as infecções oculares causadas por S. aureus em geral (p=0,001) e de 3,7% para 13,2% nas conjuntivites (p=0,001). A mesma tendência não foi observada entre as amostras de ceratite (p=0,38). Os isolados de Staphylococcus aureus resistente à meticilina mostraram maiores taxas de resistência à tobramicina, gentamicina, ciprofloxacino, gatifloxacino e moxifloxacino em comparação com os isolados de S. aureus susceptível à meticilina (p<0,001). Todos os casos foram susceptíveis à vancomicina. CONCLUSÃO:Foi observada uma tendência de aumento na prevalência do Staphylococcus aureus resistente à meticilina nas infecções oculares causadas por S. aureus, bem como taxas de resistência significantemente maiores aos antibióticos comumente utilizados na prática oftalmológica. Nossos dados alertam para a necessidade de constante vigilância de resistência bacteriana a antimicrobianos e devem ser considerados na eleição do tratamento empírico das infecções oculares.

Distribuição das ceratites infecciosas em hospital terciário no Brasil / Distribution of infectious keratitis in a tertiary hospital in Brazil

OBJETIVO: Investigar sazonalidade de ceratities infecciosas em serviço terciário no Brasil. MÉTODOS: Estudo retrospectivo de dados coletados do Laboratório de Microbiologia Ocular do Departamento de Oftalmologia da Universidade Federal de São Paulo de 2005 a 2009. Foram definidas como ceratites infecciosas aquelas com cultura positiva para o agente. Dados foram distribuídos de acordo com os meses do ano e modelos de regressão linear com variáveis "dummy" foram utilizados para testar sazonalidade. RESULTADOS: Foram diagnosticados 1.468 casos de ceratite infecciosa durante o período do estudo. Bactérias foram responsáveis por 80,3% dos casos seguidas por fungos (7%), Acanthamoeba (6%) e casos mistos (6,7%). Testes estatísticos não mostraram sazonalidade para bactérias (p=0,064), fungos (p=0,379), Acanthamoeba (p=0,062) ou casos mistos (p=0,441). CONCLUSÃO: Não foi observada sazonalidade nas ceratites infecciosas em nossa amostra.

PURPOSE: To investigate the seasonality of infectious keratitis in a tertiary hospital in Brazil. METHODS: Charts from the Ocular Microbiology Laboratory of the Department of Ophthalmology of the Federal University of Sao Paulo were reviewed from 2005 to 2009. Infectious keratitis were defined as those with positive culture. Data were distributed monthly and linear regressions with seasonal dummy models were used to test for seasonal trends. RESULTS: Total of 1,468 cases of keratitis was diagnosed during the study period. Bacterial keratitis were reponsible for 80.3% of all cases, followed by fungal (7%), and Acanthamoeba (6%); 6.7% were mixed cases. Statistical tests showed that there were no seasonal trends for bacteria (p=0.064), fungi (p=0.379), Acanthamoeba (p=0.062) or mixed infections (p=0.441). Conclusions: No seasonal trends for infectious keratitis were observed in our sample.

An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification / Surto de quarenta e cinco casos de endoftalmite aguda por Pseudomonas aeruginosa após facoemulsificação

PURPOSE: To describe an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery. Clinical findings, treatment and outcome are discussed. METHODS: Clinical charts review of forty-five patients treated for endophthalmitis in a two-day period. The patients underwent primary vitrectomy, anterior chamber irrigation and intravitreous antibiotic injection. Cultures from vitreous and anterior chamber samples were performed in all patients. RESULTS: Forty-five patients (twenty-three men and twenty-two women) were identified. The average age was 71.2 years (range, 56-83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5.5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), and light perception in thirty patients (68%). Pseudomonas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Overall, one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent evisceration or enucleation in a three-month follow-up period. CONCLUSION: Even with all the safety that cataract surgery has achieved, today, endophthalmitis remains a risk and a fearful complication of this procedure. In the present study, it was impossible to identify the source of the outbreak.

OBJETIVO: Descrever surto de endoftalmite por Pseudomonas aeruginosa após facectomia. Os achados clínicos, o tratamento e o resultado são discutidos. MÉTODOS: Revisão dos prontuários de quarenta e cinco pacientes tratados para endoftalmite em um período de dois dias. Todos os pacientes foram tratados por vitrectomia primária, irrigação da câmara anterior e injeção vítrea de antibióticos. Culturas do vítreo e de amostras de câmara anterior foram realizadas em todos os pacientes. RESULTADOS: Quarenta e cinco pacientes (23 homens e 22 mulheres) foram identificados. A idade média foi 71,2 anos (variação, 56-83 anos). O olho direito (62%) foi mais afetado do que o esquerdo (38%). O intervalo médio entre a cirurgia e a apresentação da endoftalmite foi de 5,5 dias (intervalo de 5-6 dias). A acuidade visual no momento do diagnóstico foi melhor que 20/40 em um paciente (2%), de 20/40 a 20/200 em um paciente (2%), de 20/400 para contar dedos em dois pacientes (4%), movimento de mão em onze pacientes (24%), percepção de luz em trinta pacientes (68%). Pseudomonas aeruginosa foi o agente isolado em 26 amostras de vítreo e em três amostras da câmara anterior. No geral, um paciente (2%) obteve acuidade visual final melhor que 20/40, oito pacientes (18%) obtiveram acuidade visual final de 20/40 a 20/200, seis pacientes (13%) obtiveram acuidade visual final de 20/400 para contar os dedos; onze pacientes (25%) obtiveram acuidade visual final de movimento de mão; treze pacientes (29%) obtiveram acuidade visual final de percepção de luz e seis (13%) pacientes não havia percepção luminosa no último exame. Nenhum olho foi submetido à evisceração ou enucleação em três meses de acompanhamento. CONCLUSÃO: Mesmo com toda a segurança da cirurgia de catarata nos dias atuais, endoftalmite permanece um risco e uma complicação temível deste procedimento. No presente estudo não foi possível identificar a fonte do surto.

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Etiology and epidemiological analysis of glaucoma-filtering bleb infections in a tertiary eye care hospital in south India.

Purpose: To evaluate the microbial etiology and associated risk factors among patients with blebitis following trabeculectomy. Materials and Methods: A retrospective analysis of all culture-proven blebitis was performed in patients who underwent trabeculectomy between January 2004 and December 2008. A standardized form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Swabbing of the infected bleb surface was performed for all suspected cases and further subjected to microbiological analysis. Results: A total of 23 patients with culture-proven blebitis were treated during the study period, with a mean age of 59.2 years (59.2 ± SD: 12.8; range, 30-81 years). Duration of onset was early (≤36 months) in six (26%) cases and late (> 36 months) in 17 (74%) cases with a range between 15 and 144 months (mean, 82.91 months; SD: 41.89). All 23 blebs were located superiorly and of which, 21 (91%) were microcystic avascular, 1 (4%) diffuse avascular, and 1 (4%) vascular flattened. The predominant risk factor identified was bleb leak (35%; 8 of 23) followed by thin bleb (22%; 5 of 23) and blepharitis (17%; 4 of 23). Bleb leaks (100%) were recorded only in patients with late onset (≥ 9 years) of infection (P< 0.001), while the incidence of ocular surface disease (100%) occurred early (≤3 years) (P< 0.001). Use of topical steroids was associated frequently with cases of thin blebs (80%; 4 of 5) (P< 0.001), while topical antibiotics showed bleb leaks (88%; 7 of 8) (P< 0.001). Coagulase-positive staphylococci were frequently recovered from blebitis with thin blebs (71%; 5 of 7) (P = 0.001), Coagulase-negative staphylococci (CoNS) with bleb leak (100%; 8 of 8) (P< 0.001), Corynebacterium with blepharitis (100%; 3 of 3) (P = 0.001), and Streptococci with releasable sutures (75%; 3 of 4) (P = 0.001). Conclusion Bleb leak is the principal risk factor responsible for late-onset blebitis, while early-onset blebitis could be ascribed to ocular surface diseases. Streptococci were mainly responsible for early onset of infection, while the late onset was due to CoNS.

Epidemiology and medical prediction of microbial keratitis in southeast Brazil / Epidemiologia e previsibilidade no diagnóstico clínico de ceratite microbiana no sudeste do Brasil

PURPOSE: The goals of the study were the following: 1) to show the epidemiology of microbial keratitis (MK) in the southeast Brazil, 2) to compare the epidemiological differences between fungal (FK) and bacterial keratitis (BK), and 3) to evaluate the frequency which ophthalmologists accurately differentiate bacterial keratitis from fungal keratitis based on clinical diagnosis. METHODS: A retrospective chart analysis of all clinically diagnosed microbial keratitis patients presenting between October, 2003 and September, 2006 was performed. Demographic features, ocular and laboratory findings, and information regarding the risk factors and clinical evolution were recorded. RESULTS: Among 118 consecutive patients with a clinical diagnosis of microbial keratitis, the positive culture rate was 61 percent. The predominant bacterial and fungal pathogens isolated were S. epidermidis and Fusarium spp. Prior corneal injury was more frequent among fungal keratitis than bacterial keratitis cases (p<0.0001). Coexisting systemic diseases, ocular diseases, and previous ocular surgery were more frequent among BK cases (p=0.001; p=0.001; p=0.004; respectively). The following clinical findings were more frequent in bacterial keratitis: hypopion, corneal peripheral superficial vascularisation, and ulceration area >20 mm² (p<0.05). The diagnosis was predicted correctly in 81.6 percent of bacterial keratitis cases and in 48.1 percent of fungal keratitis cases. CONCLUSION: Medical judgment of microbial keratitis agent is possible based on clinical and epidemiological data, but it is more difficult for fungal infection. Thus, such data cannot be the only basis for the diagnosis of suspected microbial keratitis, but oriented clinical suspicion based on these data may be beneficial for guiding antimicrobial treatment and earlier therapy.

OBJETIVO: Os objetivos deste estudo foram os seguintes: 1) mostrar epidemiologia da ceratite microbiana (CM) no sudeste do Brasil, 2) para comparar as diferenças epidemiológicas entre ceratites fúngicas (CF) e bacterianas (CB) e 3) avaliar a frequência com que os oftalmologistas distinguem com precisão ceratite fúngica de ceratite bacteriana baseado no diagnóstico clínico. MÉTODOS: Uma análise retrospectiva de todas as ceratites microbianas diagnosticadas clinicamente apresentando entre outubro de 2003 e setembro de 2006 foi realizada. As características demográficas, relativas ocular e de laboratório, e informações aos fatores de risco e evolução clínica foram registrados. RESULTADOS: Dentre 118 pacientes consecutivos com diagnóstico clínico de ceratite microbiana, a taxa de cultura positiva foi de 61 por cento. Os patógenos predominantes de bactérias e fungos isolados foram S. epidermidis e Fusarium spp. O trauma de córnea foi mais frequente entre os casos de ceratite fúngica do que ceratite bacteriana (p<0,0001). A coexistência de doenças sistêmicas, doenças oculares e cirurgia ocular prévia foram mais frequentes entre os casos de ceratite bacteriana (p=0,001, p=0,001, p=0,004, respectivamente). Os seguintes achados clínicos foram mais frequentes em ceratite bacteriana: hipópio, vascularização periférica da córnea superficial e área de ulceração >20 mm² (p<0,05). O diagnóstico foi corretamente estimado em 81,6 por cento dos casos de CB e em 48,1 por cento dos casos de CF. CONCLUSÃO: A presunção clínica do agente da ceratite microbiana é possível baseada em dados clínicos e epidemiológicos, mas é mais difícil para infecção fúngica. Assim, esses dados não podem ser a única base para o diagnóstico de suspeita de ceratite microbiana, mas a suspeita clínica orientada com base nesses dados pode ser benéfica para orientar o tratamento antimicrobiano e terapia precoce.

Microbial keratitis in the elderly: a 32-year review / Ceratite infecciosa em idosos: revisão de 32 anos

PURPOSE: To describe the demographic characteristics, associated factors and causative agents of infectious keratitis in the elderly in a tertiary referral center in São Paulo, Brazil. METHODS: A retrospective review of all patients aged 60 years and over with a presumptive diagnosis of infectious keratitis who had material collected for microbiological analysis, between the years 1975 and 2007 (32-year span). RESULTS: From a total of 7,060 age-independent cases of microbial keratitis, 1,545 cases in the elderly were reviewed, which had a mean age of 71.0 ± 7.8 years, ranging from 60 to 101 years. There were 707 males (45.6 percent) and 838 females (54.3 percent). Associated factors were: past ocular surgery (25.1 percent), ocular trauma (7.2 percent) and contact lens use (3.0 percent). Bacterioscopy was positive in 40.5 percent of cases. Culture positivity for any agent was 53.5 percent (bacteria 47.0 percent, fungi 6.1 percent, Acanthamoeba 0.4 percent). The most frequent bacteria were the gram-positive cocci (mostly coagulase-negative Staphylococci) and gram-negative bacilli (mostly the genera Pseudomonas, Moraxella and Proteus), while the most frequent fungi were the filamentous (mostly the genus Fusarium). CONCLUSIONS: This study represents a large series of microbial keratitis in the elderly in a single referral center. The most important factor associated with this condition in the elderly was past ocular surgery. The most frequent causative agents were bacteria, especially gram-positive cocci and gram-negative bacilli.

OBJETIVO: Descrever as características demográficas, fatores associados e agentes etiológicos das ceratites infecciosas em idosos em um centro de referência terciário em São Paulo, Brasil. MÉTODOS: Análise retrospectiva de todos os pacientes a partir de 60 anos com diagnóstico clínico de ceratite infecciosa que tiveram material colhido para análise microbiológica, entre os anos de 1975 e 2007 (intervalo de 32 anos). RESULTADOS: De um total de 7.060 casos de ceratite infecciosa em todas as idades, 1.545 casos em idosos foram revisados. A idade média foi de 71,0 ± 7,8 anos, variando de 60 a 101 anos. Foram 707 homens (45,6 por cento) e 838 mulheres (54,3 por cento). Os principais fatores associados foram: cirurgia ocular prévia (25,1 por cento), trauma ocular (7,2 por cento) e uso de lentes de contato (3,0 por cento). Bacterioscopia foi positiva em 40,5 por cento dos casos. A positividade das culturas para qualquer agente foi de 53,5 por cento (bactérias 47,0 por cento, fungos 6,1 por cento, Acanthamoeba 0,4 por cento). As bactérias mais frequentes foram os cocos gram positivos (principalmente Staphylococcus coagulase negativo) e bacilos gram negativos (principalmente Pseudomonas, Moraxella e Proteus), enquanto os fungos mais frequentes foram os filamentosos (Fusarium). CONCLUSÕES: Este estudo representa até o momento a maior série de casos de ceratite infecciosa em idosos em um centro único. O fator mais associado a esta condição em idosos foi cirurgia ocular prévia. Os agentes etiológicos mais frequentes foram as bactérias, principalmente cocos gram positivos e bacilos gram negativos.

Contact lens-related microbial keratitis.

OBJECTIVE: To review the clinical and microbiological profile in patients with contact lens-related microbial keratitis (CLRMK). MATERIAL AND METHOD: Hospital records of 435 patients with a diagnosis of microbial keratitis seen at Ramathibodi Hospital from January 1998 to December 2002 were retrospectively reviewed. All patients with CLRMK were included in the present study. RESULTS: Of the 435 cases, 81 (18.6%) were related to contact lens use. The disposable or frequent replacement of lenses were the most common lens-wearing type. Thirty-four percent of patients did not practice proper contact lens care and 67% wore contact lenses overnight. Corneal cultures were performed in 58 of 81 cases (72%) and were positive in 42 of 58 cases (72%). Pseudomonas aeruginosa was the most common organism (59%), followed by Klebsiella pneumoniae (11%). Polymicrobial infection was found in 19 cases. Most of the patients responded to medical treatment that led to the healing of ulcers whereas four patients required therapeutic penetrating keratoplasty. Most, of the organisms were sensitive to antibiotics. After treatment, 43% of the patients have continued contact lenses-wearing. CONCLUSION: CLRMK remains an essential problem in Thailand. Soft contact lens wear and overnight wearing seem to be the most important risk factors. Although the treatment outcome with medical therapy is good, keratitits may result in loss of vision. Ophthalmologist should warn contact lens wearers of this potential problem and instruct them on how to care for their lenses.

Clinico-microbiological profile and visual outcomes of post-traumatic endophthalmitis at a tertiary eye care center in South India.

PURPOSE: To analyze the clinical and microbiological characteristics of eyes with post-traumatic endophthalmitis and factors influencing the visual outcomes in these cases. METHODS: We performed a retrospective chart analysis of the clinical and microbiological data of 97 consecutive patients with post-traumatic endophthalmitis presenting to a tertiary eye care hospital in South India. RESULTS: Thirty-nine (40.2%) cases were culture-positive, gram-positive cocci (n=24/42, 57.1%) being the commonest isolates. Staphylococcus epidermidis and Pseudomonas aeuruginosa were the commonest single isolates (n=10; 23.8%). Majority of the organisms were sensitive to chloramphenicol (n=27) or ciprofloxacin (n=26). Susceptibility to vancomycin (n=3) and amikacin (n=4) was poor. Cases with negative cultures at presentation were more likely to have improvement in visual acuity compared with culture-positive cases (on multivariate analysis, OR: 3.2, 95% CI: 1.1, 9.0). CONCLUSIONS: In this series of post-traumatic endophthalmitis, a high prevalence of resistance of the culture isolates to vancomycin and amikacin was observed.

Bacterial and fungal profile of corneal ulcers--a prospective study.

Corneal ulceration continues to be one of the most important causes of ocular morbidity and blindness worldwide. Between April 1999 and May 2001, 80 patients with corneal ulceration were examined to find the causative microorganisms, the sensitivity pattern of bacterial isolates to antibiotics, the predisposing factorsfor ulcerative keratitis and the comparison between culture and gram staining results. Corneal ulceration was seen more in males than females, predominantly in farmers (61.25%) and trauma was the commonest predisposing factor, the agents being mainly organic agricultural materials. Of the 80 corneal ulcers, 32(40%) yielded pure bacterial growth while fungal growth was seen in 10(12.5%). Streptococcus pneumoniae was the commonest bacterium while Aspergillus fumigatus and Fusarium species were the commonest fungi isolated. Most of the bacterial isolates were sensitive to chloramphenicol and tetracycline followed by the quinolones. The overall sensitivity and specificity of Gram staining as compared to culture was 57.14% and 94.7% respectively.

Aspectos epidemiológicos e terapêuticos das infecções oculares em serviços de referência / Epidemiology and therapy of ocular infections in eye's hospitals

Introdução: As infecções oculares são um desafio constante na prática oftalmológica diária. Material e Métodos: Foram analisados 155 casos de infecções oculares supostamente bacterianas, atendidos nos serviços do Instituto/Fundação Hilton Rocha, de janeiro de 1996 a dezembro de 1999. Resultados: O quadro clínico predominante foi a conjuntivite (29,6 por cento), seguido pela blefarite (27,09 por cento) e úlcera de córnea (21,29 por cento). Nos casos de cultura positiva, os microorganismos mais comumente isolados foram o estafilococos epidermidis (48,12 por cento) e o estafilococos aureus (38,34 por cento). Dentre os agentes patológicos detectados, o estafilococos aureus foi o que apresentou maior resistência aos antibióticos utilizados na prática oftalmológica (41,18 por cento a ofloxacina). Conclusão: A análise laboratorial rigorosa e a escolha criteriosa dos medicamentos, muitas vezes com associação de drogas, são passos fundamentasis para o sucesso nestes casos.

Bacterial etiologic agents of ocular infection in children in the Islmic Republic of Iran

Bacterial agents of ocular infection were studied in 485 children under 14 years of age from October 1993 to February 1995. Aerobic and anaerobic bacteriological methods and antimicrobial susceptibility testing were used. Conjunctivitis was the most common clinical feature [77.9%]. Bacterial agents were detected in the ocular samples of 66.8% of children and Staphylococcus aureus was the most common causative agent, being responsible for 28% of all cases. The frequency of ocular infection in patients aged 0-2 years was significantly higher than other age groups [P = 0.04]. Approximately 84% of all bacteria were sensitive to chloramphenicol

Freqüência das infecçöes oculares por clamídia nos portadores de conjuntivite, em clínica particular de Uberaba, MG / Incidence of Chlamydia ocular infections in patients with conjunctivitis, at a private clinic of Uberaba, MG

Setecentos e oitenta pacientes com recidivas clínicas de infecçäo conjuntivas ou queixas persistentes de prurido, ardor, dor, lacrimejamento e hiperemia, foram submetidos ao raspado conjuntival com citologia e pesquisa de inclusöes. Destes 247(31,7%) apresentaram inclusöes citoplasmáticas; 235 pacientes foram, também, submetidos a coloraçäo com anticorpo monoclonal fluorescente (imunofluorescência direta - DFA) com 90 (38,3%) casos positivos. Discute-se também, a importância do quadro clínico e dos métodos laboratoriais (coloraçäo com anticorpo monoclonal fluorescente e pesquisa de inclusöes citoplasmáticas). Os pacientes fazem parte de clientela de clínica particular e tem nível sócio-econômico de médio a alto