Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore.
Cont Lens Anterior Eye. 2019 Aug;42(4):455-461. doi: 10.1016/j.clae.2019.02.006. Epub 2019 Feb 23.
To investigate the disease patterns of Microbial Keratitis(MK) in patients seen in a tertiary referral hospital, to evaluate the clinical outcomes of MK and the risk factors for poorer visual outcomes.
This is a retrospective case series of all culture-positive corneal scrapings between April 2012 and October 2016. A total of 230 patients(n = 230) were included into this study. Patient demographics, clinical information and microbiological characteristics of organisms are collected.
64.3% of patients with MK are contact lens(CL) users. Among CL users, there is a preponderance of females(68.9%) and they tend to be younger (27.1 ± 10.6 years). The most frequently isolated organism in this study is Pseudomonas aeruginosa(51.7%) with 69.6% of cases belonging to CL users. MK in non-CL users tend to involve other organisms, such as coagulase-negative Staphylococci, Staphylococcus aureus and Streptococcus pneumoniae. Pseudomonas aeruginosa exhibits good sensitivity rates to ciprofloxacin, levofloxacin and gentamicin. Non-Pseudomonas organisms display similar sensitivities to ciprofloxacin, levofloxacin and gentamicin. MK in non-CL users is related to predisposing factors of prior ocular trauma and concomitant ocular pathology. They tend to have worse visual acuity(VA) on presentation and after treatment compared to CL users. Poorer VA outcome is associated with larger ulcers, increasing age, trauma and non-CL wearers. Successful clinical outcome is achieved in 97.8% of patients, with only 2.2% requiring further surgical intervention.
CL use alters the disease patterns of MK as well as the underlying microbiological etiology. Fluoroquinolones and aminoglycosides are good empirical antibiotics for MK treatment. Early referral to a tertiary centre will likely allow for earlier treatment, which can result in better VA outcome, especially so in patients who are older, non-CL wearers and have larger ulcers with associated trauma.
调查一家三级转诊医院就诊的微生物角膜炎（MK）患者的疾病模式，评估 MK 的临床结果和影响视力预后较差的危险因素。
这是一项对 2012 年 4 月至 2016 年 10 月间所有培养阳性角膜刮片的回顾性病例系列研究。共纳入 230 例（230 例）患者进行本研究。收集患者的人口统计学资料、临床信息和微生物特征。
64.3%的 MK 患者为隐形眼镜（CL）使用者。在 CL 使用者中，女性占多数（68.9%），且年龄较小（27.1±10.6 岁）。本研究中最常分离的病原体是铜绿假单胞菌（51.7%），其中 69.6%的病例为 CL 使用者。非 CL 使用者的 MK 往往涉及其他病原体，如凝固酶阴性葡萄球菌、金黄色葡萄球菌和肺炎链球菌。铜绿假单胞菌对环丙沙星、左氧氟沙星和庆大霉素显示出良好的敏感性。非假单胞菌对环丙沙星、左氧氟沙星和庆大霉素的敏感性相似。非 CL 使用者的 MK 与既往眼部创伤和并存眼部疾病的易感因素有关。与 CL 使用者相比，他们在就诊时和治疗后视力（VA）更差。VA 预后较差与溃疡较大、年龄较大、创伤和非 CL 佩戴者有关。97.8%的患者获得了成功的临床结果，只有 2.2%的患者需要进一步手术干预。
CL 的使用改变了 MK 的疾病模式以及潜在的微生物病因。氟喹诺酮类和氨基糖苷类是治疗 MK 的经验性抗生素。早期转诊到三级中心可能会更早地进行治疗，从而获得更好的 VA 预后，尤其是年龄较大、非 CL 佩戴者和有较大溃疡伴相关创伤的患者。
