J Korean Ophthalmol Soc.  2019 Oct;60(10):935-945. 10.3341/jkos.2019.60.10.935.

Clinical Analysis of Staphylococcus Keratitis According to Coagulase Positivity

• Choi N
• Cho CH
• Lee SB

• KMID: 2460511
• DOI: http://doi.org/10.3341/jkos.2019.60.10.935

Abstract

PURPOSE
To analyze clinical aspects in a cohort of patients with Staphylococcus keratitis according to coagulase positivity (coagulase negative Staphylococcus [CNS], coagulase positive Staphylococcus [CPS]).
METHODS
Epidemiology, predisposing factors, clinical characteristics, treatment outcomes, and antibiotic susceptibility were comparatively analyzed in 138 cases of culture-proven Staphylococcus keratitis (94 eyes with CNS and 44 eyes with CPS) over 20 years (1998-2017) at Yeungnam University Hospital. Poor clinical outcomes were defined as a final corrected visual acuity <0.1, a decreased visual acuity after treatment, complications, or surgical treatment. Risk factors for poor clinical outcomes were evaluated in the total cohort and analyzed using multivariate logistic regression.
RESULTS
The most common predisposing factors were corneal trauma in the CNS group (47.9%) and previous ocular surface disease in the CPS group (31.8%). No significant differences were observed in mean age, sex, previous ocular surface disease, epithelial defect size, and hypopyon between the two groups. Methicillin susceptibility (39.4% vs. 72.7%, p < 0.001) was significantly lower in the CNS group, and poor clinical outcomes (28.0% vs. 43.9%, p = 0.076) were more common in the CPS group. The significant risk factors for poor clinical outcomes were initial best-corrected visual acuity <0.1, epithelial defect size ≥ 5 mm², symptom duration ≥10 days, and hypopyon.
CONCLUSIONS
No significant differences were observed in epidemiological factors and initial clinical characteristics between the two study groups, but predisposing factors and methicillin susceptibility differed between the two groups. Treatment outcomes were relatively worse in the CPS group than in the CNS group, but the difference was not statistically significant. Poor clinical outcomes were more associated with long symptom duration and poor initial clinical characteristics than with coagulase positivity.

Keyword

Antibiotic susceptibility; Coagulase; Keratitis; Staphylococcus

MeSH Terms

Causality
Coagulase*
Cohort Studies
Corneal Injuries
Epidemiology
Humans
Keratitis*
Logistic Models
Methicillin
Risk Factors
Staphylococcus*
Visual Acuity
Coagulase
Methicillin

Figure

• 

  Figure 1 Frequency of Staphylococcus keratitis* according to coagulase positivity during 1998-2017. CNS = coagulase negative Staphylococcus; CPS = coagulase positive Staphylococcus; S = Staphylococcus; K = Klebsiella; P = Pseudomonas; E = Enterobacter; A = Acinetobacter; spp. = species. *Total (n = 138); 9 cases had mixed infection (CNS 5 cases, CPS 4 cases): S. epidermidis, K. oxytoca, P. aeruginosa; S. epidermidis, Enterococcus faecalis; S. epidermidis, E. aerogenes; S. epidermidis, P. aeruginosa; S. epidermidis, A. baumannii; S. aureus, E. cloacae, Candida spp.; S. aureus, P. aeruginosa; S. aureus, Enterococcus faecalis; S. aureus, E. cloacae.

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