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Background: Infective keratitis is a potentially sight-threatening condition. Definitive diagnosis is by microbiological culture. So, knowledge of local etiological agents and their susceptibility helps to initiate prompt treatment and control the disease.
Aim: To determine frequency of infective keratitis (bacterial and fungal) in Kochi and analyze its aetiology, sensitivity patterns, risk factors and clinical outcome. Materials and Methods: A prospective analysis of one and half year duration of clinical samples of 49 patients with keratitis was conducted at Amrita hospital, Kochi. These were subjected to standard microbiologic processing .Relevant information was recorded using standard proforma.
Results: Only patients with culture-proven infective keratitis (n=30, 61.2%) were included for analysis. The growth pattern showed pure bacterial (43%), pure fungal (12%) and mixed (6%) type of growth patterns. Majority of patients were urban and elderly. Pre-existing ocular disorders and topical steroid usage were the predominant risk factors. Coagulase-negative Staphylococcus (41.4%) was the common bacterial isolate while Candida species (44.5%) the most common fungal isolate. Amikacin and gatifloxacin were the most effective antibiotics against bacterial isolates. There was no significant difference in susceptibility patterns of 8-methoxyfluoroquinolones among gram-negative pathogens. Resistant isolates of Coagulase-negative staphylococci to 8-methoxyfluoroquinolones were reported. Clinical outcome was better in patients with bacterial keratitis though they required more surgical interventions. Graft failure was observed in 14% of patients and 4% cases required eye removal.
Conclusion: Our study found that pre-existing ocular diseases and topical steroid usage were the common risk factors for infective keratitis. The intriguing finding of resistance to fourth-generation fluoroquinolones in present study justifies judicious use of these drugs and a future study investigating the resistance patterns of gram-positive ocular pathogens against these would be very interesting and strongly recommended.
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Author(s): Jampala S Gopinathan A Aparna Nair D Dinesh KR Radhakrishnan A Karim S
infective keratitis, bacterial keratitis, Coagulase-negative Staphylococcus, Fourth-generation fluoroquinolones, 8-methoxyfluoroquinolones