Bajracharya Leena, Bade Asta Ram, Gurung Reeta, Dhakhwa Kavita
Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
Department of Microbiology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
Clin Ophthalmol. 2020 Oct 12;14:3219-3226. doi: 10.2147/OPTH.S266218. eCollection 2020.
Infective keratitis is the most common corneal pathology in developing countries. Updated knowledge is needed for its control and proper management.
All cases of presumed microbial keratitis that presented in an 18-month period from October 2013 to March 2015 were enrolled. Data collected were demographic profile, risk factors, clinical features, and organisms isolated and their sensitivities.
A total of 602 cases of microbial keratitis were enrolled. Mean age of subjects (598 patients) was 47.9 years with 53.8% male. 64.1% worked in agriculture. 38.3% gave history of trauma followed by history of herpetic eye diseases (17.9%) and topical steroid use (14.2%). A total of 473 who were referred came at an average of 21.5 days of symptoms. 14.9% (n=90) of cases were either perforated or impending to perforate at presentation. 69.6% had infiltrate in the visual axis. A total of 516 (85.7%) underwent diagnostic corneal culture. A total of 256 (49.6%) yielded a positive result. Pure bacterial growth was seen in 111 (43.4%), pure fungal growth in 138 (53.9%), and mixed microbial growth was present in 7 (2.7%) cases. Out of 121 bacterial isolates, 95.0% were Gram positive. (45.5%, n=55) was the most common bacterial isolate followed by (20.6%, n=25). Out of 145 fungal isolates, and species were found in equal numbers (n=41, 28.3% each). Over 85% of Gram-positive organisms isolated in the study were sensitive to vancomycin, cefazolin, moxifloxacin, and gatifloxacin. Over 80% of Gram-negative organisms were sensitive to gentamicin, tobramycin, and amikacin.
Microbial keratitis and associated risk factors occurring in farmers implies a lack of awareness and prevention programs. Delay in reaching tertiary care is resulting in complicated cases. Training of local health workers for prophylaxis, updated guidelines for treating keratitis, and timely referral to higher centers are all important in a chain to decrease the incidence of microbial keratitis.
感染性角膜炎是发展中国家最常见的角膜病变。需要更新知识以对其进行控制和妥善管理。
纳入2013年10月至2015年3月这18个月期间出现的所有疑似微生物性角膜炎病例。收集的数据包括人口统计学资料、危险因素、临床特征、分离出的微生物及其敏感性。
共纳入602例微生物性角膜炎病例。受试者（598例患者）的平均年龄为47.9岁，男性占53.8%。64.1%从事农业工作。38.3%有外伤史，其次是疱疹性眼病病史（17.9%）和局部使用类固醇病史（14.2%）。总共473例转诊患者出现症状的平均天数为21.5天。14.9%（n = 90）的病例在就诊时已穿孔或即将穿孔。69.6%在视轴有浸润。总共516例（85.7%）接受了诊断性角膜培养。总共256例（49.6%）培养结果呈阳性。111例（43.4%）为单纯细菌生长，138例（53.9%）为单纯真菌生长，7例（2.7%）为混合微生物生长。在121株细菌分离物中，95.0%为革兰氏阳性菌。 （45.5%，n = 55）是最常见的细菌分离物，其次是 （20.6%，n = 25）。在145株真菌分离物中， 和 菌种数量相等（各n = 41，28.3%）。研究中分离出的革兰氏阳性菌超过85%对万古霉素、头孢唑林、莫西沙星和加替沙星敏感。超过80%的革兰氏阴性菌对庆大霉素、妥布霉素和阿米卡星敏感。
农民中发生的微生物性角膜炎及相关危险因素意味着缺乏认识和预防项目。延迟获得三级医疗导致病情复杂。培训当地卫生工作者进行预防、更新角膜炎治疗指南以及及时转诊至上级中心，对于降低微生物性角膜炎的发病率而言，都是这一环节中重要的举措。
