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Puig M, Weiss M, Salinas R, A Johnson D, Kheirkhah A. Etiology and Risk Factors for Infectious Keratitis in South Texas. JOVR [Internet]. 2020Apr.6 [cited 2024Apr.23];15(2):128–137. Available from: https://knepublishing.com/index.php/JOVR/article/view/6729
https://doi.org/10.18502/jovr.v15i2.6729
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- Cited by 11 articles
authors
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Madeleine Puig
Madeleine Puig
Department of Ophthalmology, Long School of Medicine, University of Texas Health, San Antonio, San Antonio, Texas
-
Menachem Weiss
Menachem Weiss
Department of Ophthalmology, Long School of Medicine, University of Texas Health, San Antonio, San Antonio, Texas
-
Ricardo Salinas
Ricardo Salinas
Department of Ophthalmology, Long School of Medicine, University of Texas Health, San Antonio, San Antonio, Texas
-
Daniel A Johnson
Daniel A Johnson
Department of Ophthalmology, Long School of Medicine, University of Texas Health, San Antonio, San Antonio, Texas
-
Ahmad Kheirkhah
Ahmad Kheirkhah
Department of Ophthalmology, Long School of Medicine, University of Texas Health, San Antonio, San Antonio, Texas
Published Date
- Apr 6, 2020
Etiology and Risk Factors for Infectious Keratitis in South Texas
Abstract
Purpose: To determine the causative organisms and associated risk factors for infectious keratitis in South Texas.
Methods: This retrospective study was performed at a tertiary teaching hospital system in South Texas. Medical records of all patients who presented with infectious keratitis from 2012 to 2018 were reviewed. Only patients with culture-proven bacterial, fungal, and Acanthamoeba keratitis were included.
Results: In total, 182 eyes of 181 patients had culture-proven bacterial, fungal, or Acanthamoeba keratitis. The age of patients ranged from 3 to 93 years, with a mean of 48.3 ± 20.8 years. The most common etiologic agent was bacteria, with 173 bacterial cultures (95.1%) recovered, followed by 13 fungal cultures (7.1%), and 3 Acanthamoeba cultures (1.6%). Of the 218 bacterial isolates, coagulase-negative Staphylococcus was the most common (25.7%), followed by Pseudomonas aeruginosa (23.4%), Staphylococcus aureus (11.0%), and Moraxella (7.8%). Fusarium was the most common fungal isolate (46.2%). The most common risk factors for infectious keratitis included contact lens wear (32.4%), underlying corneal disease (17.6%), trauma (14.3%), and ocular surface disease (13.7%).
Conclusions: Bacteria are the most common cause of infectious keratitis in this patient population, with coagulase-negative Staphylococcus and Pseudomonas as the most common isolates. The prevalence of culture-positive fungal keratitis is significantly lower than that of bacterial keratitis. Contact lens wear is the most common risk factor associated with infectious keratitis in South Texas.
Keywords:
Acanthamoeba, Bacteria, Corneal Ulcer, Fungus, Keratitis
References
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2. Collier SA, Gronostaj MP, MacGurn AK, Cope JR, Awsumb KL, Yoder JS, et al. Estimated burden of keratitis–United States, 2010. MMWR Morb Mortal Wkly Rep 2014;63:1027–1030.
3. McLeod SD, Kolahdouz-Isfahani A, Rostamian K, Flowers CW, Lee PP, McDonnell PJ. The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis. Ophthalmology 1996;103:23–28.
4. Rodman RC, Spisak S, Sugar A, Meyer RF, Soong HK, Musch DC. The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic. Ophthalmology 1997;104:1897–1901.
5. Forster RK. Conrad Berens Lecture. The management of infectious keratitis as we approach the 21st century. CLAO J 1998;24:175–180.
6. Baum JL. Initial therapy of suspected microbial corneal ulcers: broad antibiotic therapy based on prevalence of organisms. Surv Ophthalmol 1979;24:97–105.
7. Jin H, Parker WT, Law NW, Clarke CL, Gisseman JD, Pflugfelder SC, et al. Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital. Br J Ophthalmol 2017;101:1483–1487.
8. Erie JC, Nevitt M, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol 1993;111:1665–1671.
9. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review. Ophthalmology 1999;106:1313–1318.
10. Liesegang TJ, Forster RK. Spectrum of microbial keratitis in South Florida. Am J Ophthalmol 1980;90:38–47.
11. Varaprasathan G, Miller K, Lietman T, Whitcher JP, Cevallos V, Okumoto M, et al. Trends in the etiology of infectious corneal ulcers at the F. I. Proctor Foundation. Cornea 2004;23:360–364.
12. Lichtinger A, Yeung SN, Kim P, Amiran MD, Iovieno A, Elbaz U, et al. Shifting trends in bacterial keratitis in Toronto: an 11-year review. Ophthalmology 2012;119:1785–1790.
13. Estopinal CB, Ewald MD. Geographic disparities in the etiology of bacterial and fungal keratitis in the United States of America. Semin Ophthalmol 2016;31:345–352.
14. Wong TY, Ng TP, Fong KS, Tan DT. Risk factors and clinical outcomes between fungal and bacterial keratitis: a comparative study. CLAO J 1997;23:275–281.
15. Gorski M, Yushvayev S, Awwad A, Awwad A, Lazzaro DR. Seasonal variation in the presentation of infectious keratitis. Eye Contact Lens 2016;42:295–297.
16. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211–1215.
17. Sand D, She R, Shulman IA, Chen DS, Schur M, Hsu HY. Microbial keratitis in Los Angeles: The Doheny Eye Institute and the Los Angeles County Hospital experience. Ophthalmology 2015;122:918–924.
18. Truong DT, Bui MT, Pauras M, Cavanagh HD. Microbial keratitis at an urban county hospital: a 10-year update. Eye Contact Lens 2007;33:45–49.
19. Estopinal CB, Ewald MD. Geographic disparities in the etiology of bacterial and fungal keratitis in the United States of America. Semin Ophthalmol 2016;31:345–352.
20. Alfonso EC, Miller D, Cantu-Dibildox J, O’brien TP, Schein OD. Fungal keratitis associated with non-therapeutic soft contact lenses. Am J Ophthalmol 2006;142:154–155.
21. Alexandrakis G, Alfonso EC, Miller D. Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones. Ophthalmology 2000;107:1497–1502.
22. Hernandez-Camarena JC, Graue-Hernandez EO, Ortiz- Casas M, Ramirez-Miranda A, Navas A, Pedro-Aguilar L, et al. Trends in microbiological and antibiotic sensitivity patterns in infectious keratitis: 10-year experience in Mexico city. Cornea 2015;34:778–785.
23. Ahmed S, Ghosh A, Hassan SA, Tarafder S, Miah RA. Predisposing factors and aetiologic diagnosis of infectious corneal ulcer. Bangladesh J Med Microbiol 2010;4:28–31.
24. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol 2007;14:61–69.
25. Jeng BH, Gritz DC, Kumar AB, Holsclaw DS, Porco TC, Smith SD, et al. Epidemiology of ulcerative keratitis in Northern California. Arch Ophthalmol 2010;128:1022–1028.
26. Bourcier T, Thomas F, Borderie V, Chaumeil C, Laroche L. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 2003;87:834–838.
27. Lai TH, Jhanji V, Young AL. Microbial keratitis profile at a university hospital in Hong Kong. Int Sch Res Notices 2014:689742.
28. Ferrer C, Alió JL. Evaluation of molecular diagnosis in fungal keratitis. Ten years of experience. J Ophthalmic Inflamm Infect 2011;1:15–22.
29. Labbé A, Khammari C, Dupas B, Gabison E, Brasnu E, Labetoulle M, Baudouin C.
30. Contribution of in vivo confocal microscopy to the diagnosis and management of infectious keratitis. Ocul Surf 2009;7:41–52.
31. Das S, Constantinou M, Daniell M, Taylor HR. Moraxella keratitis: predisposing factors and clinical review of 95 cases. Br J Ophthalmol 2006;90:1236–1238.
32. Manikandan P, Varga J, Kocsubé S, Anita R, Revathi R, Németh TM, et al. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses 2013;56:26–33.
33. Keay LJ, Gower EW, Lovieno A, Oechsler RA, Alfonso EC, Matoba A, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001–2007: a multicenter study. Ophthalmology 2011;118:920–926.
34. Farrand K, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthalmol 2017;182:90–98.
35. Lin TY, Yeh LK, Ma DH, Chen PY, Lin HC, Sun CC, et al. Risk factors and microbiological features of patients hospitalized for microbial keratitis: a 10-year study in a referral center in Taiwan. Medicine (Baltimore) 2015;94:e1905.
36. Ibrahim YW, Boase DL, Cree IA. Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: the Portsmouth corneal ulcer study. Br J Ophthalmol 2009;93:1319–1324.
37. Jurkunas U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea 2009;28:638–643.
38. Rosa RH Jr, Miller D, Alfonso EC. The changing spectrum of fungal keratitis in south Florida, Ophthalmology 1994;101:1005–1013.
39. Song P, Xia W, Wang M, Chang X, Wang J, Jin S, et al. Variations of dry eye disease prevalence by age, sex and geographic characteristics in China: a systematic review and meta-analysis. J Glob Health 2018;8:020503.
40. Lin CC, Lalitha P, Srinivasan M, Prajna NV, McLeod SD, Acharya NR, et al. Seasonal trends of microbial keratitis in South India. Cornea 2012;31:1123–1127.
2. Collier SA, Gronostaj MP, MacGurn AK, Cope JR, Awsumb KL, Yoder JS, et al. Estimated burden of keratitis–United States, 2010. MMWR Morb Mortal Wkly Rep 2014;63:1027–1030.
3. McLeod SD, Kolahdouz-Isfahani A, Rostamian K, Flowers CW, Lee PP, McDonnell PJ. The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis. Ophthalmology 1996;103:23–28.
4. Rodman RC, Spisak S, Sugar A, Meyer RF, Soong HK, Musch DC. The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic. Ophthalmology 1997;104:1897–1901.
5. Forster RK. Conrad Berens Lecture. The management of infectious keratitis as we approach the 21st century. CLAO J 1998;24:175–180.
6. Baum JL. Initial therapy of suspected microbial corneal ulcers: broad antibiotic therapy based on prevalence of organisms. Surv Ophthalmol 1979;24:97–105.
7. Jin H, Parker WT, Law NW, Clarke CL, Gisseman JD, Pflugfelder SC, et al. Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital. Br J Ophthalmol 2017;101:1483–1487.
8. Erie JC, Nevitt M, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol 1993;111:1665–1671.
9. Goldstein MH, Kowalski RP, Gordon YJ. Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review. Ophthalmology 1999;106:1313–1318.
10. Liesegang TJ, Forster RK. Spectrum of microbial keratitis in South Florida. Am J Ophthalmol 1980;90:38–47.
11. Varaprasathan G, Miller K, Lietman T, Whitcher JP, Cevallos V, Okumoto M, et al. Trends in the etiology of infectious corneal ulcers at the F. I. Proctor Foundation. Cornea 2004;23:360–364.
12. Lichtinger A, Yeung SN, Kim P, Amiran MD, Iovieno A, Elbaz U, et al. Shifting trends in bacterial keratitis in Toronto: an 11-year review. Ophthalmology 2012;119:1785–1790.
13. Estopinal CB, Ewald MD. Geographic disparities in the etiology of bacterial and fungal keratitis in the United States of America. Semin Ophthalmol 2016;31:345–352.
14. Wong TY, Ng TP, Fong KS, Tan DT. Risk factors and clinical outcomes between fungal and bacterial keratitis: a comparative study. CLAO J 1997;23:275–281.
15. Gorski M, Yushvayev S, Awwad A, Awwad A, Lazzaro DR. Seasonal variation in the presentation of infectious keratitis. Eye Contact Lens 2016;42:295–297.
16. Leck AK, Thomas PA, Hagan M, Kaliamurthy J, Ackuaku E, John M, et al. Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis. Br J Ophthalmol 2002;86:1211–1215.
17. Sand D, She R, Shulman IA, Chen DS, Schur M, Hsu HY. Microbial keratitis in Los Angeles: The Doheny Eye Institute and the Los Angeles County Hospital experience. Ophthalmology 2015;122:918–924.
18. Truong DT, Bui MT, Pauras M, Cavanagh HD. Microbial keratitis at an urban county hospital: a 10-year update. Eye Contact Lens 2007;33:45–49.
19. Estopinal CB, Ewald MD. Geographic disparities in the etiology of bacterial and fungal keratitis in the United States of America. Semin Ophthalmol 2016;31:345–352.
20. Alfonso EC, Miller D, Cantu-Dibildox J, O’brien TP, Schein OD. Fungal keratitis associated with non-therapeutic soft contact lenses. Am J Ophthalmol 2006;142:154–155.
21. Alexandrakis G, Alfonso EC, Miller D. Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones. Ophthalmology 2000;107:1497–1502.
22. Hernandez-Camarena JC, Graue-Hernandez EO, Ortiz- Casas M, Ramirez-Miranda A, Navas A, Pedro-Aguilar L, et al. Trends in microbiological and antibiotic sensitivity patterns in infectious keratitis: 10-year experience in Mexico city. Cornea 2015;34:778–785.
23. Ahmed S, Ghosh A, Hassan SA, Tarafder S, Miah RA. Predisposing factors and aetiologic diagnosis of infectious corneal ulcer. Bangladesh J Med Microbiol 2010;4:28–31.
24. Bharathi MJ, Ramakrishnan R, Meenakshi R, Padmavathy S, Shivakumar C, Srinivasan M. Microbial keratitis in South India: influence of risk factors, climate, and geographical variation. Ophthalmic Epidemiol 2007;14:61–69.
25. Jeng BH, Gritz DC, Kumar AB, Holsclaw DS, Porco TC, Smith SD, et al. Epidemiology of ulcerative keratitis in Northern California. Arch Ophthalmol 2010;128:1022–1028.
26. Bourcier T, Thomas F, Borderie V, Chaumeil C, Laroche L. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 2003;87:834–838.
27. Lai TH, Jhanji V, Young AL. Microbial keratitis profile at a university hospital in Hong Kong. Int Sch Res Notices 2014:689742.
28. Ferrer C, Alió JL. Evaluation of molecular diagnosis in fungal keratitis. Ten years of experience. J Ophthalmic Inflamm Infect 2011;1:15–22.
29. Labbé A, Khammari C, Dupas B, Gabison E, Brasnu E, Labetoulle M, Baudouin C.
30. Contribution of in vivo confocal microscopy to the diagnosis and management of infectious keratitis. Ocul Surf 2009;7:41–52.
31. Das S, Constantinou M, Daniell M, Taylor HR. Moraxella keratitis: predisposing factors and clinical review of 95 cases. Br J Ophthalmol 2006;90:1236–1238.
32. Manikandan P, Varga J, Kocsubé S, Anita R, Revathi R, Németh TM, et al. Epidemiology of Aspergillus keratitis at a tertiary care eye hospital in South India and antifungal susceptibilities of the causative agents. Mycoses 2013;56:26–33.
33. Keay LJ, Gower EW, Lovieno A, Oechsler RA, Alfonso EC, Matoba A, et al. Clinical and microbiological characteristics of fungal keratitis in the United States, 2001–2007: a multicenter study. Ophthalmology 2011;118:920–926.
34. Farrand K, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthalmol 2017;182:90–98.
35. Lin TY, Yeh LK, Ma DH, Chen PY, Lin HC, Sun CC, et al. Risk factors and microbiological features of patients hospitalized for microbial keratitis: a 10-year study in a referral center in Taiwan. Medicine (Baltimore) 2015;94:e1905.
36. Ibrahim YW, Boase DL, Cree IA. Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: the Portsmouth corneal ulcer study. Br J Ophthalmol 2009;93:1319–1324.
37. Jurkunas U, Behlau I, Colby K. Fungal keratitis: changing pathogens and risk factors. Cornea 2009;28:638–643.
38. Rosa RH Jr, Miller D, Alfonso EC. The changing spectrum of fungal keratitis in south Florida, Ophthalmology 1994;101:1005–1013.
39. Song P, Xia W, Wang M, Chang X, Wang J, Jin S, et al. Variations of dry eye disease prevalence by age, sex and geographic characteristics in China: a systematic review and meta-analysis. J Glob Health 2018;8:020503.
40. Lin CC, Lalitha P, Srinivasan M, Prajna NV, McLeod SD, Acharya NR, et al. Seasonal trends of microbial keratitis in South India. Cornea 2012;31:1123–1127.