J Korean Ophthalmol Soc > Volume 56(10); 2015 > Article
Journal of the Korean Ophthalmological Society 2015;56(10):1479-1488.
DOI: https://doi.org/10.3341/jkos.2015.56.10.1479    Published online October 15, 2015.
Gram-Negative Bacterial Keratitis: A 15-Year Review of Clinical Aspects.
Eun Young Cho, Sang Bumm Lee
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. sbummlee@ynu.ac.kr
15년간 그람음성세균각막염의 임상적 고찰
영남대학교 의과대학 안과학교실
Received: 24 April 2015   • Revised: 16 July 2015   • Accepted: 4 September 2015
In this study we investigated pathogenic organisms, antibiotic susceptibility, and clinical characteristics of patients with Gram-negative bacterial keratitis and elucidated risk factors for poor visual outcomes. METHODS: The authors performed a retrospective chart review of 161 eyes (169 isolates) with Gram-negative bacterial keratitis between January 1998 and December 2012 at Yeungnam University Hospital. The study was divided into 5 periods for analysis of the bacteriological profiles and in vitro antibiotic sensitivity. The epidemiological and clinical characteristics were compared according to 3 groups (Pseudomonas species, Enterobacter species, and Serratia marcescens). Additionally, logistic regression analysis was performed to determine the risk factors. RESULTS: The prevalence of Gram-negative organisms increased from 34.7 to 73.2% between the 1st and 5th periods (p < 0.001). Pseudomonas spp. was the most commonly isolated organism (55 eyes, 32.5%) over the total period, followed by Enterobacter spp. (41 eyes, 24.3%) and Serratia marcescens (33 eyes, 19.5%). The effective antibiotics against Gram-negative bacterial pathogens isolated from culture were cefepime (94.5%), levofloxacin (93.4%), ciprofloxacin (93.0%), and amikacin (92.3%). The incidence was higher in the elderly over 60 years of age and in early adulthood patients in their 20s and 30s. The frequent predisposing factors were contact lens wearing and corneal trauma. S. marcescens had the shortest corneal epithelium healing time (p = 0.012) and the most favorable visual outcome after treatment (p = 0.004) compared with the other species. Risk factors for poor visual outcomes included a best corrected visual acuity less than 0.1 at initial evaluation (p < 0.001) and central corneal lesion (p = 0.027). CONCLUSIONS: Gram-negative bacterial keratitis tended to increase and Pseudomonas spp. was the most common isolate. The clinical prognosis was most favorable in S. marcescens. Early diagnosis of Gram-negative bacterial keratitis and appropriate antibiotic selection including cefepime, quinolone, or amikacin are recommended.
Key Words: Enterobacter species;Gram-negative bacterial keratitis;Pseudomonas species;Serratia marcescens

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