Lamas-Francis David, Navarro Daniel, Mansilla Raquel, de-Rojas Victoria, Moreno Claudio, Dios Enrique, Rigueiro Jesús, Álvarez Dolores, Crego Paloma, Rodríguez-Ares Teresa, Touriño Rosario
Department of Ophthalmology, University Hospital of Santiago de Compostela, Ramón Baltar s/n, Santiago de Compostela, 15706, Spain.
Department of Microbiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Eur J Clin Microbiol Infect Dis. 2025 Jan;44(1):53-61. doi: 10.1007/s10096-024-04978-6. Epub 2024 Nov 7.
To review the risk factors, clinical characteristics, and microbiological profiles of microbial keratitis cases, as well as the antibiotic resistance patterns of bacterial isolates in the region of Galicia, Spain.
This retrospective case series includes patients with culture-positive non-viral microbial keratitis between 2010 and 2020, treated at nine hospitals within the region of Galicia, North-West Spain. The standard protocol involved Gram staining for bacterial infections and calcofluor white staining for fungal or amoebal infections, identification by MALDI-TOF mass spectrometry or microscopy, and antimicrobial susceptibility interpreted according to EUCAST or CLSI guidelines.
780 microorganisms were isolated from corneal scraping cultures from 654 patients. 36.9% resided in urban areas, and 63.1% in rural areas. Isolates were more frequently collected in spring and summer. The median time to corneal scraping was 0 days (IQR 0-2), and the median time to epithelialisation was 24.0 days (IQR 11-49). Most cases had a single corneal infiltrate (509 cases; 77.8%) and affected the stroma (432; 66.1%), with small (< 3 mm) epithelial defects (347; 53.1%). Significant risk factors included contact lens wear (24.2%) and exposure to organic matter (4.9%). The most frequent bacteria was CoNS (207; 26.4). Fungi (77; 9.9%) and amoebae (6; 0.8%) were less common. Steroid use and eyelid disease increased resistance in CoNS species. An increase in the percentage of MRSA (compared to MSSA) was detected over the study period (p = 0.045).
In Galicia (Spain), microbial keratitis was mostly attributed to CoNS. An increase in MRSA keratitis was observed. Analysis of risk factors may help in suspecting antibiotic resistance. Surveillance programs for detecting the development of antimicrobial resistance are necessary to provide treatment guidelines based on local data.
回顾西班牙加利西亚地区微生物性角膜炎病例的危险因素、临床特征和微生物学特征，以及细菌分离株的抗生素耐药模式。
本回顾性病例系列研究纳入了2010年至2020年间在西班牙西北部加利西亚地区的9家医院接受治疗的培养阳性非病毒性微生物性角膜炎患者。标准方案包括对细菌感染进行革兰氏染色，对真菌或阿米巴感染进行荧光增白剂染色，通过基质辅助激光解吸电离飞行时间质谱或显微镜进行鉴定，并根据欧洲抗菌药物敏感性试验委员会（EUCAST）或美国临床和实验室标准协会（CLSI）指南解释抗菌药物敏感性。
从654例患者的角膜刮片培养物中分离出780种微生物。36.9%的患者居住在城市地区，63.1%居住在农村地区。分离物在春季和夏季收集得更为频繁。角膜刮片的中位时间为0天（四分位间距0 - 2），上皮化的中位时间为24.0天（四分位间距11 - 49）。大多数病例有单个角膜浸润（509例；77.8%），累及基质（432例；66.1%），伴有小的（<3mm）上皮缺损（347例；53.1%）。显著的危险因素包括佩戴隐形眼镜（24.2%）和接触有机物（4.9%）。最常见的细菌是凝固酶阴性葡萄球菌（CoNS，207例；26.4%）。真菌（77例；9.9%）和阿米巴（6例；0.8%）较少见。使用类固醇和眼睑疾病增加了CoNS菌株的耐药性。在研究期间检测到耐甲氧西林金黄色葡萄球菌（MRSA，与甲氧西林敏感金黄色葡萄球菌相比）的百分比有所增加（p = 0.045）。
在西班牙加利西亚地区，微生物性角膜炎主要归因于CoNS。观察到MRSA角膜炎有所增加。对危险因素的分析可能有助于怀疑抗生素耐药性。有必要开展监测项目以检测抗菌药物耐药性的发展，从而根据当地数据提供治疗指南。
