J Korean Ophthalmol Soc.  2019 Nov;60(11):1027-1036. 10.3341/jkos.2019.60.11.1027.

Clinical Analysis of Bacterial Keratitis According to Culture Positivity

Affiliations
  • 1Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. sbummlee@ynu.ac.kr

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical aspects of inpatients with bacterial keratitis according to culture positivity.
METHODS
This was a retrospective review of 98 cases of inpatients with bacterial keratitis who were treated between January 2011 and December 2016 in Yeungnam University Hospital. Epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between culture positive (CP, 39 eyes) and culture negative (CN, 59 eyes) groups. Risk factors for poor clinical outcome were evaluated in the total cohort and analyzed using multivariate logistic regression.
RESULTS
Pseudomonas spp. (31%) and Staphylococcus spp. (24%) were common in the CP group. There were no significant differences in previous ocular surface disease, contact lens wear, or hypopyon between the two groups. Epithelial defect size ≥5 mm² (51%:31%, p = 0.04) and initial visual acuity <0.1 (Snellen) (51%:31%, p = 0.04) were significantly higher in the CP group than in the CN group. Epithelial healing time ≥14 days (18%:5%, p = 0.08) and poor clinical outcome (28%:20%, p = 0.37) were more common in the CP group than in the CN group. Risk factors for poor clinical outcome were previous ocular surface disease (odds ratio [OR] = 11.29, 95% confidence interval [CI] = 2.01-63.41, p = 0.006) and previous ocular surgery (OR = 6.98, 95% CI = 1.51-32.20, p = 0.01).
CONCLUSIONS
The CP group showed relatively worse initial clinical characteristics than the CN group. Treatment outcomes were slightly worse in the CP group than in the CN group; however, this difference was not statistically significant. Previous ocular surface disease and previous ocular surgery were associated with poor clinical outcome.

Keyword

Bacterial infection; Corneal ulcer; Keratitis

MeSH Terms

Bacterial Infections
Causality
Cohort Studies
Corneal Ulcer
Epidemiology
Humans
Inpatients
Keratitis*
Logistic Models
Pseudomonas
Retrospective Studies
Risk Factors
Staphylococcus
Visual Acuity

Figure

  • Figure 1 Visual acuity comparison of culture positive (CP) and culture negative (CN) group at enrollment and final visit. On the box-whisker plots, the boxes include 50% of the measured values (between the 25th and 75th percentiles) and the median (horizontal line). The error bars indicate 1.5 times the interquartile distance from the upper and lower box edges. The outliers (values more than 1.5 interquartile ranges from the box) are shown as circles and the extreme values (values more than 3.0 interquartile ranges from the box) are shown as triangles. p-values were obtained by paired t-test (between enrollment and final visit) and independent t-test (between CP and CN). Hand motions, light perception (LP), and no LP were assigned values of 2.3, 2.6, and 2.9, respectively.


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