Infectious keratitis in southern Brazil: a comparison culture negative and culture positive patients

Duarte, Maria Cecília Barros; Becker, Guilherme Nardi; Muller, Guilherme Gubert; Tuon, Felipe Francisco

doi:10.5935/0034-7280.20200009

Brasil

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Rev. bras.oftalmol. 79 (1) • Jan-Feb 2020 • https://doi.org/10.5935/0034-7280.20200009 linkcopy

Infectious keratitis in southern Brazil: a comparison culture negative and culture positive patients

Ceratite infecciosa no sul do Brasil: comparação entre pacientes com cultura negativa e positiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purpose: To compare clinical-epidemiological profile and treatment outcome between culture negative and culture positive keratitis patients.

Methods: Patients with suspected infectious keratitis seen at two ophthalmic hospitals in Curitiba, Brazil, between June 2014 and April 2016, were prospectively studied. Ophthalmological exam with corneal scraping and microbiological tests were performed. Data regarding follow up, surgical interventions and treatment outcome were collected after 12 weeks of the first visit trough medical chart review. From the results of the culture, two groups were formed: culture negative keratitis (CNK) and culture positive keratitis (CPK).

Results: According to inclusion criteria 21 patients were classified as culture negative keratitis and 20 patients as culture positive keratitis. The number of patients on antibiotic drops at the first visit was greater in CNK group (90.5% versus 60%; p=0.032). Surgical procedures were necessary in 3 patients (15%) in CNK group and in 7 patients (36,8%) in CPK group (p=0.155). Treatment success was achieved by 85% (17/20) of the patients in CNK group and by 61% (11/18) of the patients in CPK group (p=0.144). There was no significant difference between groups regarding age, gender, place of residence, presence of comorbidities, risk factors for infectious keratitis, duration of symptoms and characteristics of corneal ulcer.

Conclusions: Previous treatment with antibiotics correlates with negative culture results. There was no significant difference in treatment outcome between culture negative and culture positive keratitis patients.

Keywords: Infectious keratitis; Microbial keratitis; Corneal ulcer; Microbial culture; Antibiotic drops

Systemic comorbidities	Culture negative	Culture positive
Arterial hypertension (AHT)	1	3
Diabetes Melitus (DM)	1	1
AHT + DM	0	2
Ocular comorbidities
Ocular allergy	2	0
Keratoconus	1	0
Penetrating keratoplasty	1	1
Aniridia/aphacia	1	0
Glaucoma	1	2
Glaucoma + amaurosis	0	2
Macular scar	0	1
High myopia	1	0
Facial paralysis	1	0
Risk factors
Contact lens	6	6
Ocular trauma	3	5
Contact lens + trauma	1	0
Bullous keratopathy + contact lens	1	2
Exposure keratopathy	1	0
Chronic use of corticosteroids	0	2

Duration of symptoms *	Previous treatment (n=12)	Smear result	Culture result
150	Moxifloxacin, pdn1%	Negative	Acanthamoeba sp.
10	Moxifloxacin, acyclovir, pdn1%	Amoeba cysts	Acanthamoeba sp.
14	Moxifloxacin, 0.1% dexamethasone	Negative	Non-identified yeasts
21	Moxifloxacin	Negative	Coagulase negative Staphylococci
2	Moxifloxacin	Gram-negative bacilli	Pseudomonas sp.
10	Moxifloxacin	Negative	Aspergillus fumigatus
60	Ofloxacin, PHMB	Negative	Acanthamoeba sp.
10	Ciprofloxacin, acyclovir	Hyphae	Acremonium sp
30	Moxifloxacin	Hyphae	Phoma spp.
9	Gatifloxacin 0.5%, 0.1% dexamethasone	Hyphae	Fusarium sp.
10	Vancomycin, gentamicin	Hyphae	Aspergillus niger
20	Gatifloxacin 0.5%	Hyphae	Fusarium sp.

Bacteria n=9	Number of patients
Streptococcus pneumoniae	2
Staphylococcus coagulase-negative	1
Staphylococcus aureus	1
Pseudomonas sp.	3
Moraxella sp.	1
Serratia marcescens	1
Fungi n=8
Fusarium sp.	3
Aspergillus fumigatus	1
Aspergillus niger	1
Phoma sp	1
Acremonium sp.	1
Non-identified yeast	1
Amoeba	3

	Previous medication	Medication prescribed after culture results	Surgical procedures and outcome
Started medication only after corneal scrapings	'	(n=2) 4-generation Fluoroquinolone	Cure (n=2)
Continued medication on previous use	(N=13) 4-generation fluoroquinolone	(n=13) 4-generation Fluoroquinolone	Cure (n=11) BCL (n=1) Epk (n=1)
Change or association of medication	(N=1) Moxifloxacin + 0.1% Dexamethasone	(n=1) Moxifloxacin	Cure (n=1)
	(N=3) Moxifloxacin	(N=1) Moxifloxacin + Natamycin 5% (N=1) Cefazolin + Gentamicin + Amphotericin b (N=1) vancomycin	Cure (n=3)
	(N=2) Gatifloxacin 0.5%	(N=1) Gatifloxacin 0.5% + Amphotericin b (N=1) Vancomycin + Amikacin	Cure (n=1) Epk + globe evisceration (n=1)

Corneal ulcer characteristics	Culture negative patients	Culture positive patients	p-value
Size (average area)	7.1 ±7.3 (1-24.7)	10.7 ±11.3 (1-50.2)	0.165
Location
Central	14	13
Paracentral	6	6
Peripheric	1	1
Hypopyon	4	8	0.181

	Culture negative patients	Culture positive patients	p-value
Surgical procedure
BCL	1	0
ePK	1	1
Globe evisceration	0	3
AC wash	0	2
ePK and globe evisceration	1	0
AC wash + ePK	0	1
Total	3	7	p=0.155
Treatment response
Treatment success	17/20 (85%)	11/18 (61%)	P= 0.144
Treatment failure	3/20 (15%)	7/18 (39%)
Lost follow up	1	2

vertical_align_top file_download show_chart

more_horizclose
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Oftalmologia Rua São Salvador, 107 , 22231-170 Rio de Janeiro - RJ - Brasil, Tel.: (55 21) 3235-9220, Fax: (55 21) 2205-2240 - Rio de Janeiro - RJ - Brazil
E-mail: rbo@sboportal.org.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro

[TFN1] n=number of patients; BCL =tissue adhesive with bandage contact lens; ePK = emergency penetrating keratoplasty;