Analysis on Elderly Inpatients with Infectious Keratitis: Causative Organisms, Clinical Aspects, and Risk Factors

ABSTRACT

PURPOSE: To investigate the difference of the epidemiological, microbiological, and clinical characteristics and risk factors of inpatients with infectious keratitis between an elderly group (group I > or = 60 years) and a younger group (group II < 60 years). METHODS: A retrospective chart review of 255 eyes (male/female 158/97 eyes, I/II 116/139 eyes) with infectious keratitis hospitalized at Yeungnam University Hospital between January 2004 and December 2008 was performed. RESULTS: The proportion of bacterial/fungal/herpes viral keratitis was 42/31/27% in group I and 74/8/17% in group II. The proportion of fungal keratitis in relation to bacterial keratitis was higher in group I, as compared to group II (p < 0.001). The ratio of Gram-positive/negative bacteria was 43/30% in group I and 48/46% in group II. The proportion of Gram-positive bacteria in relation to Gram-negative bacteria was higher in group I, as compared to group II (p = 0.025). The most commonly isolated microorganisms were Staphylococcus epidermidis (I/II 9/10 eyes) among Gram-positive bacteria, Enterobacter species (I 6 eyes) and Pseudomonas aeruginosa (II 9 eyes) among Gram-negative bacteria, and Candida species (I 6 eyes, II 2 eyes) among fungi. Clinical aspects and treatment outcomes, such as previous ocular surgery (I/II 23/9%), hypertension (26/7%), diabetes mellitus (17/7%), presentation at our clinic after 1 week (43/16%), initial visual acuity less than 0.1 (54/32%), hypopyon (28/15%), epithelial healing time (16/10 days), corneal perforation (18/5%), operative treatment (23/7%), and final visual acuity less than 0.1 (36/14%) were statistically significantly poorer in group I, as compared to group II. Risk factors for unimproved visual outcomes included fungal keratitis in group I and previous ocular surgery and ocular surface disease in group II. CONCLUSIONS: Considering that clinical aspects and treatment outcomes are poor in elderly inpatients with infectious keratitis, special efforts are necessary for a more accurate differential diagnosis and appropriate early treatment to achieve successful treatment outcomes.