Risk Factors, Outcomes, and Prognosis of Bacterial Keratitis

Pavankumar Kamat

September 03, 2021

According to a study published in  Frontiers in Medicine,  bacterial keratitis (BK) is a significant ocular morbidity in the UK, which not only affects visual outcomes but also increases the health care burden, as hospitalisation is often required for intensive medical treatment and/or surgical intervention.

Researchers conducted a retrospective study of 283 patients (n=283 eyes) with BK who presented to the Queen's Medical Centre, Nottingham, between 2015 and 2019. Data on demographic factors, risk factors, outcomes and prognostic factors were analysed.

Risk factors for BK were identified in 96.5% of patients, the most common being ocular surface diseases (47.3%), contact lens use (35.3%) and systemic immunosuppression (18.4%). Contact lens use was commonly linked to Pseudomonas aeruginosa infections, whereas Staphylococci spp. frequently played a role in non-contact lens-related BK (P=.017).

Culture-positive BK was significantly associated with older age (P=.004), previous corneal surgery (P=.011), poorer corrected-distance-visual-acuity (CDVA; P<.001), topical corticosteroid use (P=.008), larger size of epithelial defect/infiltrate (P<.001), centrally or paracentrally located ulcer (P=.002), presence of hypopyon (P<.001) and the need for intensive treatment in hospital (P<.001) compared with culture-negative BK.

Hospitalisation was needed for 57.2% of patients (mean length of stay, 8.0±8.3 days). Medical treatment alone was adequate for 83.7% of patients, whereas 16.3%of patients needed additional surgical interventions.

Complete corneal healing occurred in 98.2% of patients, with 55.5% of patients having a corneal healing time of >30 days. Prognostic factors for poor corneal healing (>30 days for complete healing) included age >50 years (P=.030), right eye involvement (P=.033), infiltrate size >3 mm (P=.018) and CDVA of <0.6 logMAR (P=.013).

The authors call for the development of improved preventative strategies directed towards the common risk factors for BK. "As the visual outcome of BK is affected by the initial severity of the infection and the presenting vision, the importance of 'prevention is better than cure' cannot be overemphasised" they stated.

Ting DSJ, Cairns J, Gopal BP, Ho CS, Krstic L, Elsahn A, Lister M, Said DG, Dua HS. Risk Factors, Clinical Outcomes, and Prognostic Factors of Bacterial Keratitis: The Nottingham Infectious Keratitis Study. Front Med (Lausanne). 2021;8:715118. doi: 10.3389/fmed.2021.715118. PMID: 34458289

This article originally appeared on Univadis, part of the Medscape Professional Network.

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