J Korean Ophthalmol Soc.  2014 Oct;55(10):1432-1444. 10.3341/jkos.2014.55.10.1432.

Clinical and Microbiological Analysis of Gram-Positive Bacterial Keratitis, a 15-Year Review

• Kim MR
• Lee SB

• KMID: 2216860
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1432

Abstract

PURPOSE
To investigate the shifting trends of pathogenic organisms, antibiotic resistance, and clinical characteristics of patients with Gram-positive bacterial keratitis and to elucidate the prognostic factors.
METHODS
We performed a retrospective chart review of 152 isolates in 146 eyes with Gram-positive bacterial keratitis between January 1998 and December 2012. The study was divided into 5 periods for analysis of the bacteriological profiles and in vitro antibiotic resistance. The epidemiological and clinical characteristics were compared according to bacterial isolates. Logistic regression analysis was performed to determine the risk factors.
RESULTS
Gram-positive bacterial keratitis tended to decrease and significant change in the distribution of isolates was not observed. Commonly isolated organisms were S. epidermidis (48.7%), S. aureus (25.0%), and S. pneumoniae (7.2%) in order of frequency. The resistance to fluoroquinolone tended to increase (p = 0.104) and resistance to gentamicin was significantly decreased (p = 0.01). S. epidermidis had the shortest corneal epithelium healing time (p = 0.035) and the most favorable visual outcome after treatment (p = 0.035) compared with the other species. Risk factors for poor visual outcomes included a best corrected visual acuity less than 0.1 at initial evaluation and an epithelial healing time greater than 10 days.
CONCLUSIONS
Gram-positive bacterial keratitis tended to decrease and S. epidermidis was the most common isolate. The clinical prognosis was most favorable in S. epidermidis. The BCVA less than 0.1 at initial evaluation was an important risk factor for poor visual outcome and surgical treatment in Gram-positive bacterial keratitis.

Keyword

Enterococcus species; Gram-positive bacterial keratitis; Staphylococcus aureus; Staphylococcus epidermidis; Streptococcus species

MeSH Terms

Drug Resistance, Microbial
Epithelium, Corneal
Gentamicins
Humans
Keratitis*
Logistic Models
Pneumonia
Prognosis
Retrospective Studies
Risk Factors
Staphylococcus aureus
Staphylococcus epidermidis
Visual Acuity
Gentamicins

Figure

• 

  Figure 1. Prevalence of Gram-positive bacterial isolates in total bacterial keratitis during 1998-2012. The p-value was calculated using chi-square test to com pare the distribution of the Gram-positive bacterial isolates between 2 periods. *Gram-positive bacterial isolates significantly decreased between 2 periods.

• 

  Figure 2. Organisms and shifting trend in Gram-positive bacterial isolates during 1998-2012. *Six eyes had mixed infection of 2 Gram-positive bacterial species (S. epidermidis & S. aureus (2 eyes), S. epidermidis & E. feacalis, S. epidermidis & S. sanguis, S. aureus & E. feacalis, S. dysgalactiae & S. pyogenes); †The p-value was calculated using Spearman rank correlation coefficient to compare the distribution of the bacterial isolates for 15 years. CNS = coagulase-negative Staphylococcus.

• 

  Figure 3. Trends in antimicrobial resistance of Gram-positive bacterial isolates. *The resistance of gentamicin decreased significantly (p = 0.01, Spearman rank correlation coefficient); †N1 = number of isolates with resistance; N2 = number of tested isolates; ‡The p-value was calculated using Spearman rank correlation coefficient to compare the distribution of the antimicrobial resistance for 15 years; §Total value of fluoroquinolone: ciprofloxacin (n = 70), norfloxacin (n = 21), levofloxacin (n = 25), and moxifloxacin (n = 21).

• 

  Figure 4. Trends in antimicrobial resistance to oxacillin in S. epidermidis and S. aureus. Oxacillin resistance of S. epidermidis was significantly higher than that of S. aureus (p = 0.001, Chi-square test).

Reference

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