Analysis of Inpatients with Bacterial Keratitis Over a 12-Year Period: Pathogenic Organisms and Antibiotic Resistance

ABSTRACT

PURPOSE: To investigate the distribution of bacterial keratitis isolates and the shifting trends of in vitro antibiotic susceptibility of the isolates for inpatients with bacterial keratitis. METHODS: Three hundred ninety-two bacterial isolates with 366 positive culture cases from consecutive corneal scrapes of 988 clinically diagnosed bacterial keratitis inpatients hospitalized at Yeungnam University Hospital between January 1998 and December 2009 were retrospectively reviewed. The bacteriological profiles and in vitro resistance were evaluated in the first and second six-year periods. RESULTS: The percentage of positive cultures was 37.0% (366/988). The commonly isolated Gram-positive and Gram-negative organisms were S. epidermidis (98; 25.0%) and P. aeruginosa (41; 10.5%), respectively. The ratio of Gram-positive to Gram-negative isolates was 1.241. The Gram-positive isolates significantly decreased compared to the Gram-negative isolates in the last six-year period (45.3% versus 54.7%, respectively) relative to those in the first six-year period (66.1% versus 33.9%, respectively). S. epidermidis and S. aureus decreased, and E. cloacae, S. marcescens, and S. maltophilia increased in the last six-year period. The resistance of fluoroquinolone to the Gram-positive isolates, though not statistically significant, tended to increase to 34.1% from 21.5% (p=0.061), and the methicillin-resistant S. aureus tended to increase to 54.2% from 30.0% (p=0.055). CONCLUSIONS: S. epidermidis and P. aeruginosa were the most common bacterial keratitis isolates in Gram-positive and Gram-negative isolates. The Gram-positive isolates tended to decrease, though the Gram-negative organisms tended to increase in the last six-year period compared to the first six-year period. Empirical antibiotic selection should be based on local susceptibility patterns and distribution of bacterial isolates.