Cornea & Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Ocular Microbiology Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India.
Br J Ophthalmol. 2023 Jun;107(6):769-773. doi: 10.1136/bjophthalmol-2021-320203. Epub 2022 Mar 28.
To study the incidence, clinical features and outcomes of multidrug-resistant (MDR) bacterial keratitis.
All cases of MDR-bacterial keratitis presenting to our institute over a period of 2 years were retrospectively analysed. Details of risk factors, size and depth of infiltrate, treatment, and outcome were noted. Antibiotic susceptibility tests were done on the ocular isolates from the culture of samples obtained from ocular infections, and resistance or sensitivity of the organisms to the commonly used antibiotics was studied.
Forty patients were diagnosed with MDR-bacterial keratitis in the study period. The mean age of patients was 50.9±25.4 years. Most common risk factors were vegetative trauma (n=12, 30.0%), followed by corneal transplantation (n=7, 17.5%) and systemic comorbidities (n=7, 17.5%). Infiltrate was small (<6 mm) in 22 (55%) and large (>6 mm) in 18 (45%) patients. It involved the superficial, mid and deep stroma in 11 (27.5%), 9 (22.5%) and 15 (37.5%) cases, respectively. Gram-negative bacilli (n=18, 45%) were the maximum, among which (15%) was the most common. Resistance to 3 (n=17, 42.5%) and 4 (n=17, 42.5%) classes of antibiotics was the most commonly observed. One (2.5%) patient showed resistance to all seven classes of drugs tested. Complete resolution of infection was seen in 15 (37.5%) MDR patients on medical management alone. Five (12.5%) patients underwent therapeutic penetrating keratoplasty. Size of the infiltrate was found to have a significant correlation with the outcome (p=0.002).
MDR keratitis, despite being a challenge to treat, can be successfully managed by medical therapy alone, if appropriate therapy is started early in the clinical course.
研究多药耐药（MDR）细菌性角膜炎的发病率、临床特征和结局。
对我院 2 年来收治的 MDR 细菌性角膜炎患者进行回顾性分析。记录危险因素、浸润大小和深度、治疗及结局等详细资料。对眼部感染标本培养的眼部分离物进行抗生素药敏试验，研究细菌对常用抗生素的耐药性或敏感性。
研究期间共诊断 40 例 MDR 细菌性角膜炎患者。患者平均年龄为 50.9±25.4 岁。最常见的危险因素是植物性外伤（n=12，30.0%），其次是角膜移植（n=7，17.5%）和全身合并症（n=7，17.5%）。浸润大小为小（<6mm）的患者有 22 例（55%），大（>6mm）的患者有 18 例（45%）。浅层、中层和深层基质受累分别为 11 例（27.5%）、9 例（22.5%）和 15 例（37.5%）。革兰氏阴性杆菌（n=18，45%）最多，其中最常见的是（15%）。观察到对 3（n=17，42.5%）和 4（n=17，42.5%）类抗生素的耐药性最常见。1 例（2.5%）患者对测试的 7 类药物均耐药。单纯药物治疗即可使 15 例（37.5%）MDR 患者完全治愈。5 例（12.5%）患者行治疗性穿透性角膜移植术。浸润大小与结局有显著相关性（p=0.002）。
MDR 角膜炎虽然治疗具有挑战性，但如果在临床病程早期开始适当治疗，单纯药物治疗也可成功控制。
