Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Cornea. 2023 Jun 1;42(6):702-707. doi: 10.1097/ICO.0000000000003179. Epub 2022 Nov 21.
This study aimed to review clinical features, causative organisms, complications, and outcome of bacterial keratitis cases at a tertiary eye hospital.
A retrospective study was conducted on clinically diagnosed bacterial keratitis cases from 2007 to 2019. Poor outcome was flagged if any of the following was identified: final visual acuity (VA) worse than 20/200, decrease in VA (1 line or worse compared with presenting VA), corneal perforation, endophthalmitis, failed graft, or cases requiring enucleation or evisceration.
The study included 263 cases of bacterial keratitis with 169 cases (64.3%) of culture-positive bacterial keratitis. Gram-positive bacteria were found to be the causative organism in 106 cases (62.8%). The most common types were coagulase-negative staphylococci (23.1%) and Pseudomonas (23.1%). Culture-positive bacterial keratitis was associated with the development of anterior chamber reaction (≥1+) on multivariate analysis [adjusted odds ratio (OR): 3.03, confidence interval (CI): 1.23-7.45, P = 0.016]. The complications that occurred in the current cohort included visually significant scar (64.7%), perforation (10.8%), cataract (8.8%), nonhealing epithelial defects (8.0%), corneal neovascularization (4.9%), endophthalmitis (4.6%), and hypotony (1.5%). On multivariate analysis, diabetes mellitus (adjusted OR: 3.51, CI: 1.59-7.76, P = 0.002), poor presenting best-corrected VA (adjusted OR: 3.95, CI 1.96-7.96, P < 0.001), and positive cultures (adjusted OR: 2.36, CI: 1.11-5.00, P = 0.025) were associated with poor outcome.
Culture-negative keratitis had less severe infection and better outcomes when compared to culture-positive bacterial keratitis. Factors associated with poor outcome included diabetes, poor presenting VA, and positive cultures.
本研究旨在回顾一家三级眼科医院的细菌性角膜炎病例的临床特征、病原体、并发症和转归。
对 2007 年至 2019 年临床诊断为细菌性角膜炎的病例进行回顾性研究。如果出现以下任何一种情况，则标记为预后不良：最终视力（VA）低于 20/200、VA 下降（与就诊时 VA 相比下降 1 行或更差）、角膜穿孔、眼内炎、移植失败或需要眼球摘除或眼内容剜除的病例。
本研究纳入了 263 例细菌性角膜炎患者，其中 169 例（64.3%）为培养阳性细菌性角膜炎。革兰阳性菌被发现是 106 例（62.8%）的病原体。最常见的类型是凝固酶阴性葡萄球菌（23.1%）和铜绿假单胞菌（23.1%）。在多变量分析中，培养阳性细菌性角膜炎与前房反应（≥1+）的发展相关[校正优势比（OR）：3.03，95%置信区间（CI）：1.23-7.45，P=0.016]。本研究队列中发生的并发症包括明显的视力瘢痕（64.7%）、穿孔（10.8%）、白内障（8.8%）、不愈合的上皮缺损（8.0%）、角膜新生血管（4.9%）、眼内炎（4.6%）和低眼压（1.5%）。在多变量分析中，糖尿病（校正 OR：3.51，95%CI：1.59-7.76，P=0.002）、就诊时最佳矫正视力差（校正 OR：3.95，95%CI：1.96-7.96，P<0.001）和培养阳性（校正 OR：2.36，95%CI：1.11-5.00，P=0.025）与不良预后相关。
与培养阳性细菌性角膜炎相比，培养阴性角膜炎的感染程度较轻，预后较好。与不良预后相关的因素包括糖尿病、就诊时 VA 差和培养阳性。
