Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin.

PURPOSE: Patients presenting with presumed infective keratitis were studied to determine predisposing factors, the current susceptibilities of the bacterial isolates to a range of relevant antibiotics, the success rate of topical antibiotic treatment of keratitis and predictors of failure of topical therapy. METHODS: Corneal scrapings taken from patients who presented between January 2002 and December 2003 to the Sydney Eye Hospital Emergency Department with keratitis were cultured. The minimum inhibitory concentration of selected antibiotics was determined for each bacterial isolate using an agar dilution technique. RESULTS: One hundred and twelve consecutive patients presented with corneal ulcers. Forty-seven of the 112 (42%) patients had a growth from the corneal scraping. Potential predisposing factors were identified in 64% of patients, most frequently contact lens wear (36% of patients). Coagulase-negative staphylococci were the most common species isolated. Other common organisms isolated include Pseudomonas aeruginosa, Corynebacterium spp., Staphylococcus aureus and Streptococcus spp. CONCLUSIONS: Most microorganisms isolated from patients with bacterial keratitis showed susceptibility to ciprofloxacin and aminoglycosides. Cephalothin plus aminoglycoside constituted an effective initial broad-spectrum antibiotic combination. The success rate of topical antibiotic treatment of corneal abscess is 89%. Predictors of failure include older age group, medium or large ulcer, culture-negative keratitis, hypopyon and poor visual acuity.

Endoluminal repair of abdominal aortic aneurysm prevents enlargement of the proximal neck: a 9-year life-table and 5-year longitudinal study.

OBJECTIVE: Endoluminal repair of abdominal aortic aneurysm (AAA) is predicated on stability of the proximal neck of the aneurysm. Reports on morphologic changes in the proximal neck after endoluminal repair of AAA have thus far been limited in duration to 3 years or less. The aim of this study was to document changes in diameter of the proximal neck of AAA in a group of patients who had undergone endoluminal repair between 5 and 9 years previously. METHODS: Between May 1992 and December 1996, 61 patients with AAA were treated with endoluminal repair by the senior author. The following patients were excluded from the study group: those requiring primary conversion to open repair at the original operation (n = 8), those with false aneurysm (n = 1), and those with dissection in the proximal neck (n = 1). Fifty-one patients (48 men and three women) with a mean age of 71 years remained in the study group. The endoprostheses used were modified Parodi (n = 4), Endovascular Technologies (n = 14), White-Yu (n = 10), Stentor/Vanguard (n = 21), and Bard 1996 prototype (n = 2). Morphologic changes in the proximal aortic neck were studied with contrast computed tomographic scan with the methodology recommended by the Ad Hoc Committee for Standardized Reporting Practices for Endovascular AAA Repair (revised version). The maximum transverse diameter of the proximal neck was measured 1 cm below the most inferior renal artery. A Kaplan-Meier analysis was performed showing the proportion of patients at risk with a demonstrated enlargement of the neck at each interval of time compared with the predischarge computed tomographic scan. A longitudinal study of morphologic changes in the proximal aortic neck was also undertaken in 28 patients with successful endoluminal repair who survived 5 years. RESULTS: The Kaplan-Meier curve showed a probability of no dilatation of the proximal neck of 0.943 at 7 years after endoluminal AAA repair. Of 28 patients with 5 years of follow-up after discharge, only two had increases in the diameter of the proximal neck greater than 2 mm. The endograft in both patients had undergone migration before any proximal neck dilation. A paired t test showed that the overall average increase of 0.4 mm (standard error, 0.3 mm) in these 28 patients was not statistically significant (P =.23). CONCLUSION: A high probability (0.943 at 7 years) exists of no enlargement of the proximal neck of AAA after endoluminal repair. We hypothesize that endografts positioned correctly immediately below the renal arteries protect the proximal neck from dilatation in a manner that does not occur after open repair of AAA.