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Chen YC, Hsiao YT, Kuo SF, Yu HJ, Fang PC, Ho RW, Yang IH, Kuo MT. Monitoring the transition from corneal ulceration to healed scar using a Scheimpflug tomography-based densitometry. Graefes Arch Clin Exp Ophthalmol 2024; 262:2189-2198. [PMID: 38349421 DOI: 10.1007/s00417-024-06390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/29/2023] [Accepted: 01/22/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE To compare corneal haze between active ulcer and healed scarring using a Scheimpflug densitometry. MATERIALS AND METHODS A prospective longitudinal study enrolled 30 patients (30 eyes) with ulcerative keratitis (UK). Each subject's corneal optical density (COD) was measured with a Scheimpflug corneal densitometry, Pentacam® AXL (Oculus GmbH, Wetzlar, Germany), at the active ulcerative and complete scarring stage. The COD data were analyzed through distinct methods (inbuilt, sorted annular partitions, and ulcer-matching densitometric maps). We compared different CODs to select the better index for clinically monitoring the transition from corneal ulceration to healed scar. RESULTS The CODs of the periphery (P = 0.0024) and outside of the active ulcer (P = 0.0002) significantly decreased after scarring. Partitioning the cornea into different depths and annular zones, the anterior layer, center layer, and the 2-6 mm annular zone had a more remarkable COD decrease after scar formation. The 3rd-sorted COD in the anterior layer revealed the highest area under the receiver-operating characteristic curves (0.709), in which 90% of subjects had COD reduction during the ulcer-to-scar transition. CONCLUSIONS Aside from subjective judgment based on clinical signs, the Scheimpflug tomography-based densitometry could provide objective and efficient monitoring of the corneal opacity evolution in UK patients. Because the 3rd-sorted annular COD is a better index than the inbuilt or mapping CODs in differentiating active ulcers from healed scars, this COD could be a clinically promising parameter to monitor the progression of UK patients.
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Affiliation(s)
- Yen-Cheng Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Shu-Fang Kuo
- Department of Laboratory Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, 83301, Taiwan
- Department of Laboratory Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, 261363, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, College of Medicine, Chang Gung University, Taoyuan City, 333323, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist, Kaohsiung City, 83301, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan.
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Tsao YC, Huang YH. Impact of SARS-CoV-2 pandemic and lockdown measures on microbial keratitis in Taiwan. Int Ophthalmol 2024; 44:238. [PMID: 38904686 DOI: 10.1007/s10792-024-03200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE This study aimed to evaluate how the SARS-CoV-2 pandemic and associated lockdown measures influenced microbial keratitis in Taiwan by comparing demographic data, predisposing factors, pathogen profiles, and treatment outcomes in 2019 and 2020. METHODS Data from patients diagnosed with microbial keratitis at National Chung Kung University Hospital between January 2019 and December 2020 were examined, focusing on patient demographics, predisposing factors, isolated pathogens, antibiotic usage, and clinical progress. RESULTS No significant differences were found in patient sex, laterality, or average age between the two years. Predisposing factors, such as contact lens use and chronic ocular/systemic disorders, remained unchanged. While fungal isolates slightly increased during the lockdown, bacterial isolates remained consistent. Medical treatment effectiveness, treatment strategies, and antibiotic susceptibility for common bacteria showed no significant alterations. CONCLUSION Despite the challenges posed by the SARS-CoV-2 pandemic and lockdown measures, this study revealed minimal changes in microbial keratitis trends in Taiwan. This highlights the importance of maintaining access to medical care during crises and offers insights into potential treatment strategies for patients facing difficulties in receiving timely care. Further research should investigate the pandemic's impact on healthcare access and patient outcomes in various populations and regions.
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Affiliation(s)
- Yu-Chien Tsao
- College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, 70101, Taiwan.
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Ispizua Mendivil E, Durán de la Colina JA. Infectious keratitis associated with contact lens wear: REGINFECOR multicenter study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:237-247. [PMID: 38588998 DOI: 10.1016/j.oftale.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/27/2024] [Indexed: 04/10/2024]
Abstract
This 32-centre multicentre study addresses the lack of knowledge about the prevalence and significance of microbial keratitis (MK) associated with contact lens (CL) wear in Spain. A total of 304 cases recruited from 32 hospitals were studied and showed that infectious keratitis associated with contact lens wear mainly affects young women during the summer months. In this study, soft lenses with monthly replacement and single solution cleaning were most commonly used, purchased and fitted in opticians' shops. Common risk factors were identified among users, such as topping off solutions, prolonging the life of lenses, and frequently sleeping, swimming and showering with lenses. Overnight lens wear was significantly associated with a higher incidence of corneal opacities, and the presence of Pseudomonas aeruginosa in bacterial cultures was associated with more severe sequelae and a greater need for corneal transplantation. Although most cases were benign, the time taken to heal was long, which poses a problem for working patients. This study provides valuable epidemiological, microbiological and risk factor information and estimates the incidence of CL related MK in Spain to be approximately 1 case per 30,000 inhabitants per year.
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Affiliation(s)
- E Ispizua Mendivil
- Departamento de Oftalmología, Hospital de Urduliz, Urduliz, Bizkaia, Spain.
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Bălășoiu AT, Bălășoiu M, Zlatian OM, Ghenea AE. Bacterial and Fungal Keratitis in a Tertiary Care Hospital from Romania. Microorganisms 2024; 12:787. [PMID: 38674731 PMCID: PMC11052338 DOI: 10.3390/microorganisms12040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/16/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Infectious keratitis is a significant global problem that can lead to corneal blindness and visual impairments. This study aimed to investigate the etiology of infectious bacterial and fungal keratitis, identify the causative pathogens and their antimicrobial resistance patterns, and analyze the risk factors associated with the development of infectious keratitis. The study was observational and retrospective, involving 226 eyes from 223 patients presented at the Ophthalmology Clinic of the County Clinical Emergency Hospital of Craiova, Romania. The inclusion criteria included corneal ulceration/abscess/infiltrate present on slit-lamp examination and positive microbiological sampling for bacteria or fungi. The study found that the most common causes of infectious keratitis were coagulase-negative staphylococci (35.40%), Staphylococcus aureus (11.06%), and Pseudomonas aeruginosa (14.16%). The Gram-positive bacteria showed high resistance rates to penicillin, moderate rates to gentamycin and clindamycin, and low resistance to chinolones. The Gram-negative bacteria were highly resistant to ampicillin and amoxicillin-clavulanic acid, while third-generation cephalosporins, quinolones, and carbapenems were effective. Systemic antibiotics, such as vancomycine, piperacillin-tazobactam, amikacin, and ceftazidime, show promise against keratitis with low resistance rates, whereas carbapenems and topical aminoglycosides had higher resistance, leaving moxifloxacin as a potential topical option for Gram-positive bacteria and Pseudomonas aeruginosa, albeit with resistance concerns for Klebsiella spp. Although fungal keratitis was rare, Fusarium spp. and Candida albicans were the leading fungal pathogens, with incidences of 2.65% and 2.21%, respectively. Candida albicans was broadly susceptible to most antifungals, while Fusarium solani, Curvularia lunata, and Alternaria alternata exhibited resistance to many antifungals. Amphotericin B and caspofungin can be used as systemic antifungals in fungal keratitis. The study also identified risk factors for keratitis such as ocular trauma (65.92%, OR: 2.5), contact lens wear (11.94%, OR: 1.8), and corneal scarring/leukoma (10.17%, OR: 1.6). Keratitis was more frequent in individuals over 60 years old. The findings of this study have implications for the development of effective diagnostic, therapeutic, and preventive strategies for infectious keratitis.
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Affiliation(s)
- Andrei Theodor Bălășoiu
- Ophtalmology Department, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
- Ophtalmology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Bălășoiu
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ovidiu Mircea Zlatian
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alice Elena Ghenea
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Garg P, Khor WB, Roy A, Tan DTH. A survey of Asian Eye Institutions on perioperative antibiotic prophylaxis in cataract surgery. Int Ophthalmol 2023; 43:4151-4162. [PMID: 37526782 PMCID: PMC10520096 DOI: 10.1007/s10792-023-02816-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia. METHODS An online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis. RESULTS All surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance. CONCLUSION There are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.
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Affiliation(s)
| | - Wei-Boon Khor
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Aravind Roy
- LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Donald Tiang-Hwee Tan
- Singapore National Eye Centre, Singapore, Singapore.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
- Eye and Cornea Surgeons, Eye and Retina Surgeons, Camden Medical Center, 1 Orchard Boulevard, #13-03, Singapore, 248649, Singapore.
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Shekhawat NS, Hall LN, Sulewski ME, Woreta F, Wang J, Smith K, Kuo IC. Corneal Culture and Antibiotic Susceptibility Results for Microbial Keratitis in the Mid-Atlantic Region of the United States, 2016 to 2020. Eye Contact Lens 2023; 49:267-274. [PMID: 37166232 PMCID: PMC10330016 DOI: 10.1097/icl.0000000000000993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To examine the microbial distribution and antimicrobial susceptibility of culture-positive microbial keratitis at a large tertiary referral center in the mid-Atlantic region of the United States. METHODS Retrospective review of culture-positive microbial keratitis cases at the Wilmer Eye Institute from 2016 through 2020. RESULTS Of the 474 culture-positive microbial keratitis cases, most were bacterial (N=450, 94.9%), followed by fungal (N=48, 10.1%) and Acanthamoeba keratitis (N=15, 3.1%). Of the 450 bacterial isolates, 284 (69.5%) were gram-positive organisms, whereas 157 (28.4%) were gram-negative organisms. The most common bacterial species isolated was coagulase-negative Staphylococcus spp (N=154, 24.8%), and the most common gram-negative isolate was Pseudomonas aeruginosa (N=76, 12.3%). Among fungi, the most common isolates were Candida (N=25, 45.4%), whereas Fusarium (N=6, 10.9%) and Aspergillus (N=3, 5.5%) were less common. Of the 217 bacterial isolates tested for erythromycin susceptibility, 121 (55.7%; ∼60% of coagulase-negative staphylococci and corynebacteria tested) showed resistance to erythromycin. CONCLUSIONS Microbial keratitis in the Baltimore Mid-Atlantic region of the United States is most commonly caused by bacteria, with fungi and acanthamoeba being less common. Gram-positive bacterial infections predominate. Among fungal keratitis cases, Candida species are more commonly encountered than are filamentous species. Use of erythromycin as infection prophylaxis should be reexamined. Findings from our study may guide empiric treatment in this geographic region.
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Affiliation(s)
- Nakul S. Shekhawat
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leangelo N. Hall
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E. Sulewski
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kerry Smith
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irene C. Kuo
- Wilmer Eye Institute, Department of Ophthalmology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
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7
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Nanayakkara U, Khan MA, Hargun DK, Sivagnanam S, Samarawickrama C. Ocular streptococcal infections: A clinical and microbiological review. Surv Ophthalmol 2023:S0039-6257(23)00036-X. [PMID: 36764397 DOI: 10.1016/j.survophthal.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Streptococcus is a diverse bacterial genus that is part of the ocular surface microbiome implicated in conjunctivitis, keratitis, endophthalmitis, dacryocystitis, and orbital cellulitis which can lead to decreased visual acuity and require surgical intervention. The pathophysiology of S. pneumoniae is well established and the role of the polysaccharide capsule, pneumolysin, neuraminidases, and zinc metalloproteinases in ocular infections described. Additionally, key virulence factors of the viridans group streptococci such as cytolysins and proteases have been outlined, but there is a paucity of research on the remaining streptococcus species. These virulence factors tend to result in aggressive disease. Clinically, S. pneumoniae is implicated in 2.7-41.2% of bacterial conjunctivitis cases, more predominant in the pediatric population, and is implicated in 1.8-10.7% of bacterial keratitis isolates. Streptococcus bacteria are significantly implicated in acute postoperative, post-intravitreal, and bleb-associated endophthalmitis, responsible for 10.3-37.5, 29.4, and 57.1% of cases, respectively. Group A and B streptococcus endogenous endophthalmitis is rare, but has a very poor prognosis. Inappropriate prescription of antibiotics in cases of non-bacterial aetiology has contributed to increasing resistance, and a clinical index is needed to more accurately monitor this. Furthermore, there is an increasing need for prospective, surveillance studies of antimicrobial resistance in ocular pathogens, as well as point-of-care testing using molecular techniques.
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Affiliation(s)
| | | | | | - Shobini Sivagnanam
- Blacktown Hospital, Sydney, Australia; Australian Clinical Labs, Bella Vista, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney, Australia; Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute for Medical Research, Australia.
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Wang JJ, Lai CH, Chen CY, Liu CY, Lin MH, Yang YH, Wu PL. Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns. Diagnostics (Basel) 2022; 12:diagnostics12092095. [PMID: 36140496 PMCID: PMC9497811 DOI: 10.3390/diagnostics12092095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Infectious keratitis (IK) represents a major cause of corneal blindness. This study aims to investigate the demographics, risk factors, microbiological characteristics and antibiotic susceptibility patterns of IK in Taiwan over the past 15 years. A retrospective population-based study was conducted using the Chang Gung Research Database. Patients with IK were identified by diagnostic codes for corneal ulcer from 2004 to 2019. Of 7807 included subjects, 45.2% of patients had positive corneal cultures. The proportion of contact lens-related IK declined, while that of IK related to systemic diseases grew. The percentage of isolated gram-positive bacteria surpassed that of gram-negative bacteria in the 15-year period. The prevalence of Pseudomonas aeruginosa showed a decreasing trend (p = 0.004), whereas coagulase-negative Staphylococcus (CNS) and Propionibacterium species were increasingly detected (p < 0.001). Overall, the trend of antibiotic susceptibility of both gram-positive and gram-negative bacteria did not change throughout the study period. The susceptibility to the test antibiotics maintained over 90% in gram-negative isolates over 15 years. Vancomycin preserved 100% susceptibility to all gram-positive isolates. Since most tested antibiotics exhibited stable susceptibility over decades, this study reinforced that fluoroquinolones and fortified vancomycin continue to be good empiric therapies for treating bacterial keratitis in Taiwan.
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Affiliation(s)
- Jin-Jhe Wang
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chien-Hsiung Lai
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chau-Yin Chen
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yao-Hsu Yang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Pei-Lun Wu
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Correspondence: ; Tel.: +886-5-3621000 (ext. 2580)
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Bahatheg G, Kuppusamy R, Yasir M, Black DS, Willcox M, Kumar N. Short Tryptamine-Based Peptoids as Potential Therapeutics for Microbial Keratitis: Structure-Function Correlation Studies. Antibiotics (Basel) 2022; 11:antibiotics11081074. [PMID: 36009943 PMCID: PMC9404767 DOI: 10.3390/antibiotics11081074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Peptoids are peptidomimetics that have attracted considerable interest as a promising class of antimicrobials against multi-drug-resistant bacteria due to their resistance to proteolysis, bioavailability, and thermal stability compared to their corresponding peptides. Staphylococcus aureus is a significant contributor to infections worldwide and is a major pathogen in ocular infections (keratitis). S. aureus infections can be challenging to control and treat due to the development of multiple antibiotic resistance. This work describes short cationic peptoids with activity against S. aureus strains from keratitis. The peptoids were synthesized via acid amine-coupling between naphthyl-indole amine or naphthyl-phenyl amine with different amino acids to produce primary amines (series I), mono-guanidines (series II), tertiary amine salts (series III), quaternary ammonium salts (series IV), and di-guanidine (series V) peptoids. The antimicrobial activity of the peptoids was compared with ciprofloxacin, an antibiotic that is commonly used to treat keratitis. All new compounds were active against Staphylococcus aureus S.aureus 38. The most active compounds against S.aur38 were 20a and 22 with MIC = 3.9 μg mL−1 and 5.5 μg mL−1, respectively. The potency of these two active molecules was investigated against 12 S. aureus strains that were isolated from microbial keratitis. Compounds 20a and 22 were active against 12 strains with MIC = 3.2 μg mL−1 and 2.1 μg mL−1, respectively. There were two strains that were resistant to ciprofloxacin (Sa.111 and Sa.112) with MIC = 128 μg mL−1 and 256 μg mL−1, respectively. Compounds 12c and 13c were the most active against E. coli, with MIC > 12 μg mL−1. Cytoplasmic membrane permeability studies suggested that depolarization and disruption of the bacterial cell membrane could be a possible mechanism for antibacterial activity and the hemolysis studies toward horse red blood cells showed that the potent compounds are non-toxic at up to 50 μg mL−1.
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Affiliation(s)
- Ghayah Bahatheg
- School of Chemistry, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Department of Chemistry, Faculty of Science, University of Jeddah, Jeddah 21589, Saudi Arabia
| | - Rajesh Kuppusamy
- School of Chemistry, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- School of Optometry and Vision Science, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Correspondence: (R.K.); (N.K.)
| | - Muhammad Yasir
- School of Optometry and Vision Science, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - David StC. Black
- School of Chemistry, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Naresh Kumar
- School of Chemistry, The University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Correspondence: (R.K.); (N.K.)
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Huang TE, Ou JH, Hung N, Yeh LK, Ma DHK, Tan HY, Chen HC, Hung KH, Fan YC, Sun PL, Hsiao CH. Fusarium Keratitis in Taiwan: Molecular Identification, Antifungal Susceptibilities, and Clinical Features. J Fungi (Basel) 2022; 8:jof8050476. [PMID: 35628732 PMCID: PMC9144221 DOI: 10.3390/jof8050476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
We performed molecular identification and antifungal susceptibilities of pathogens and investigated clinical features of 43 culture-proven Fusarium keratitis cases from 2015–2020 in Taiwan. The pathogens were identified by sequencing of their internal transcribed spacer regions of ribosomal DNA and translation elongation factor 1α gene; their antifungal susceptibilities (to seven agents) were determined by broth microdilution method. We also collected clinical data to compare the drug susceptibilities and clinical features of Fusarium solani species complex (FSSC) isolates with those of other Fusarium species complexes (non-FSSC). The FSSC accounted for 76.7% pathogens, among which F. falciforme (32.6%) and F. keratoplasticum (27.9%) were the most common species. Among clinically used antifungal agents, amphotericin B registered the lowest minimal inhibitory concentration (MIC), and the new azoles efinaconazole, lanoconazole and luliconazole, demonstrated even lower MICs against Fusarium species. The MICs of natamycin, voriconazole, chlorhexidine, lanoconazole, and luliconazole were higher for the FSSC than the non-FSSC, but no significant differences were noted in clinical outcomes, including corneal perforation and final visual acuity. In Taiwan, the FSSC was the most common complex in Fusarium keratitis; its MICs for five tested antifungal agents were higher than those of non-FSSC, but the clinical outcomes did not differ significantly.
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Affiliation(s)
- Tsung-En Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Jie-Hao Ou
- Department of Plant Pathology, National Chung Hsing University, Taichung 402, Taiwan;
| | - Ning Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Yun-Chen Fan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Pei-Lun Sun
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
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11
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Kang Y, Tian L, Gu X, Chen Y, Ma X, Lin S, Li Z, Lou Y, Zheng M. Characterization of the Ocular Surface Microbiome in Keratitis Patients after Repeated Ophthalmic Antibiotic Exposure. Microbiol Spectr 2022; 10:e0216221. [PMID: 35293804 PMCID: PMC9045205 DOI: 10.1128/spectrum.02162-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022] Open
Abstract
In human medicine, antibiotics have been widely used to treat microbial infections. The extensive use of antibiotics is a leading cause of antibiotic resistance. Currently, the influence of the use of antibiotics on the ocular surface microbiome in the course of keratitis treatment remains to be explored in depth. We performed metagenomic analyses in a cohort of 26 healthy controls (HCs), 28 keratitis patients (KPs) who received antibiotics [KP (abx+) group], and 12 KPs who were antibiotic naive [KP (abx-) group]. We identified that the dissimilarities in microbial community structure (Bray-Curtis and Jaccard analyses) between the KP (abx+) group and the HC group were greater than those between the KP (abx-) group and the HC group. Pseudomonas lactis, P. aeruginosa, Pseudomonas sp. FDAARGOS_380, Pseudomonas sp. J380, Corynebacterium simulans, Streptococcus pyogenes, Finegoldia magna, and Aspergillus oryzae had no statistically significant differences between the KP (abx+) and KP (abx-) groups but did have statistically significant differences between the KP (abx+) and HC groups and between the KP (abx-) and HC groups. Among them, Pseudomonas lactis, P. aeruginosa, Pseudomonas sp. FDAARGOS_380, and Pseudomonas sp. J380 were identified as possible hosts carrying multidrug-resistant genes. The total abundance and number of antibiotic resistance genes (ARGs) were greater in the KP (abx+) group than in the HC and KP (abx-) groups. The functional profile analysis of ocular surface microbiota revealed that pathogenesis-related functional pathways and virulence functions were enriched in KPs. In conclusion, our results show that empirical antibiotic treatment in KPs leads to increases in the antibiotic resistance of ocular surface microbiota. IMPORTANCE Treatment for keratitis is based on appropriate antimicrobial therapy. A direct correlation between antibiotic use and the extent of antibiotic resistance has been reported. Therefore, knowledge of the antibiotic resistance patterns of ocular surface microbial flora in KPs is important for clinical treatment. To the best of our knowledge, this is the first study to use metagenomic approaches to investigate the associations between ophthalmic antibiotic use and the ocular surface microbiome of KPs. Monitoring the microbiota and antibiotic resistome profiles for the ocular surface has huge potential to help ophthalmologists choose the appropriate antibiotics and will thereby improve the efficacy of treatment regimens, which has important implications for reducing the development of antibiotic resistance of the ocular surface to a certain extent.
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Affiliation(s)
- Yutong Kang
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Leihao Tian
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaobin Gu
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiju Chen
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueli Ma
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shudan Lin
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongliang Lou
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiqin Zheng
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
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12
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Mahjoub A, Hadj Salah S, Gayed N, Ben Abdessalem N, Krifa F, Knani L, Hachemi M. Severe corneal abscess: epidemiology and clinicobacteriological aspect. LA TUNISIE MEDICALE 2022; 99:632-637. [PMID: 35244915 PMCID: PMC8795994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AIM To assess epidemiological, clinical and microbiological characteristics of patients presenting with a clinically diagnosed severe corneal abscess at the Farhat Hached Hospital Department of Ophthalmology (Sousse). METHODS A retrospective, descriptive and anlalytic study of patients presenting severe corneal abscess was conducted over 5 years, from january 1st of 2013 to septembre 3Oth of 2017. The epidemiological, clinical and microbiological aspects, were analyzed. RESULTS one hundred and one of of 100 patients were presented severe corneal abscess. The mean age was 54,1 ans years old. The mean delay for referral was 15,5days. The most frequent Risk factor was chronic keratopathy noted in 59% ofcases. Corneal trauma was noted in (30%) and use of contact lenses in (12%).Visual acuity was less than 1/10 in 72% of the patients. Bacteriological cultures isolated an organism in 39.9 % of cases. Coagulase-negative Staphylococcus (23,3%), Pseudomonas aeruginosa (16,7%), streptococcus (13,3%) were the most frequent species that have been found. CONCLUSION A good preliminary analysis of the risk factors, the mode of infection, and the appropriate search for the incriminated germs, allow secondarily an adequate management of the severe corneal abscesses.
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13
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Hatcher JB, de Castro-Abeger A, LaRue RW, Hingorani M, Mawn L, Donahue SP, Sternberg P, Shieh C. MRSA Decolonization and the Eye: A Potential New Tool for Ophthalmologists. Semin Ophthalmol 2022; 37:541-553. [DOI: 10.1080/08820538.2022.2039220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jeremy B Hatcher
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alex de Castro-Abeger
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Richard W LaRue
- Department of Medicine, Division of Infectious Disease, Vanderbilt Medical Center, Nashville, TN, United States
| | - Melanie Hingorani
- Department of Paediatrics, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Louise Mawn
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sean P Donahue
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Paul Sternberg
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christine Shieh
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
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14
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Pathogens and Antibiotic Susceptibilities of Global Bacterial Keratitis: A Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11020238. [PMID: 35203840 PMCID: PMC8868051 DOI: 10.3390/antibiotics11020238] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Bacterial keratitis (BK) is the most common type of infectious keratitis. The spectrum of pathogenic bacteria and their susceptibility to antibiotics varied with the different regions. A meta-analysis was conducted to review the global culture rate, distribution, current trends, and drug susceptibility of isolates from BK over the past 20 years (2000–2020). Four databases were searched, and published date was limited between 2000 and 2020. Main key words were “bacterial keratitis”, “culture results” and “drug resistance”. Forty-two studies from twenty-one countries (35 cities) were included for meta-analysis. The overall positive culture rate was 47% (95%CI, 42–52%). Gram-positive cocci were the major type of bacteria (62%), followed by Gram-negative bacilli (30%), Gram-positive bacilli (5%), and Gram-negative cocci (5%). Staphylococcus spp. (41.4%), Pseudomonas spp. (17.0%), Streptococcus spp. (13.1%), Corynebacterium spp. (6.6%) and Moraxella spp. (4.1%) were the most common bacterial organism. The antibiotic resistance pattern analysis revealed that most Gram-positive cocci were susceptive to aminoglycoside (86%), followed by fluoroquinolone (81%) and cephalosporin (79%). Gram-negative bacilli were most sensitive to cephalosporin (96%) and fluoroquinolones (96%), followed by aminoglycoside (92%). In Gram-positive cocci, the susceptibility trends of fluoroquinolones were decreasing since 2010. Clinics should pay attention to the changing trends of pathogen distribution and their drug resistance pattern and should diagnose and choose sensitive antibiotics based on local data.
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15
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Kuo MT, Hsu BWY, Lin YS, Fang PC, Yu HJ, Chen A, Yu MS, Tseng VS. Comparisons of deep learning algorithms for diagnosing bacterial keratitis via external eye photographs. Sci Rep 2021; 11:24227. [PMID: 34930952 PMCID: PMC8688438 DOI: 10.1038/s41598-021-03572-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/30/2021] [Indexed: 02/08/2023] Open
Abstract
Bacterial keratitis (BK), a painful and fulminant bacterial infection of the cornea, is the most common type of vision-threatening infectious keratitis (IK). A rapid clinical diagnosis by an ophthalmologist may often help prevent BK patients from progression to corneal melting or even perforation, but many rural areas cannot afford an ophthalmologist. Thanks to the rapid development of deep learning (DL) algorithms, artificial intelligence via image could provide an immediate screening and recommendation for patients with red and painful eyes. Therefore, this study aims to elucidate the potentials of different DL algorithms for diagnosing BK via external eye photos. External eye photos of clinically suspected IK were consecutively collected from five referral centers. The candidate DL frameworks, including ResNet50, ResNeXt50, DenseNet121, SE-ResNet50, EfficientNets B0, B1, B2, and B3, were trained to recognize BK from the photo toward the target with the greatest area under the receiver operating characteristic curve (AUROC). Via five-cross validation, EfficientNet B3 showed the most excellent average AUROC, in which the average percentage of sensitivity, specificity, positive predictive value, and negative predictive value was 74, 64, 77, and 61. There was no statistical difference in diagnostic accuracy and AUROC between any two of these DL frameworks. The diagnostic accuracy of these models (ranged from 69 to 72%) is comparable to that of the ophthalmologist (66% to 74%). Therefore, all these models are promising tools for diagnosing BK in first-line medical care units without ophthalmologists.
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Affiliation(s)
- Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan (R.O.C.). .,School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan.
| | - Benny Wei-Yun Hsu
- Department of Computer Science, National Yang Ming Chiao Tung University, No. 1001, Daxue Rd., East Dist., Hsinchu City, 300, Taiwan (R.O.C.)
| | - Yi-Sheng Lin
- Department of Computer Science, National Yang Ming Chiao Tung University, No. 1001, Daxue Rd., East Dist., Hsinchu City, 300, Taiwan (R.O.C.)
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan (R.O.C.).,School of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan (R.O.C.)
| | - Alexander Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan (R.O.C.)
| | - Meng-Shan Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan (R.O.C.)
| | - Vincent S Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, No. 1001, Daxue Rd., East Dist., Hsinchu City, 300, Taiwan (R.O.C.).
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16
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Xu S, Guo D, Liu X, Jin X, Shi Y, Wang Y, Zhang N, Zhang H. Ocular pathogens and antibiotic resistance in microbial keratitis over three years in Harbin, Northeast China. Acta Ophthalmol 2021; 99:909-915. [PMID: 33565253 PMCID: PMC9542897 DOI: 10.1111/aos.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 01/06/2023]
Abstract
Purpose Understanding the spectrum of ocular pathogens in a given geographic region is important for devising appropriate practical treatment. Therefore, we examined the pathogen spectrum and antibiotic resistance of microbial keratitis in northeast China. Methods In this retrospective observational study, we reviewed the microbiology laboratory records of patients diagnosed with microbial keratitis in a tertiary eye hospital in Harbin, northeast China, between 2017 and 2019, and analysed the pathogen spectrum and antibiotic susceptibility. Results We collected 462 specimens, of which 282 exhibited positive cultures. Among these cultures, 257 were bacterial and 25 were fungal. Of the 257 bacterial isolates, 214 (83.27%) were gram positive whereas 43 (16.73%) were gram negative. The most prevalent gram‐positive pathogen was coagulase‐negative staphylococcus (CoNS; 58.37%), followed by Staphylococcus aureus (S. aureus; 20.62%) and Streptococcus pneumoniae (2.33%). Of the gram‐negative bacterial isolates, 10 were Pseudomonas aeruginosa (3.89%). The most frequently detected ocular pathogens from fungal isolates were Fusarium species (40%). We also found more culture‐positive cases of bacterial keratitis in summer. Overall, 16.98% S. aureus and 64.00% CoNS isolates were methicillin resistant. These methicillin‐resistant bacteria were also more likely to be resistant to other antibiotics, with multidrug resistance found in 77.78% methicillin‐resistant S. aureus and 90.63% methicillin‐resistant CoNS. However, all gram‐positive isolates were sensitive to vancomycin and linezolid. Conclusion Coagulase‐negative staphylococcus are the most common ocular pathogens in northeast China. We also show the prevalence of methicillin resistance and concurrent multidrug resistance among staphylococcal isolates. Monitoring the patterns of antimicrobial resistance could help in the management selection.
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Affiliation(s)
- Shuo Xu
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Dawen Guo
- Department of Clinical Laboratory The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Xintian Liu
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Xin Jin
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Yan Shi
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Yingbin Wang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Nan Zhang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Hong Zhang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
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17
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Enzor R, Bowers EM, Perzia B, Perera C, Palazzolo L, Mammen A, Dhaliwal DK, Kowalski RP, Jhanji V. Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers. Am J Ophthalmol 2021; 227:1-11. [PMID: 33657419 DOI: 10.1016/j.ajo.2021.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group. DESIGN Retrospective cohort study METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed. RESULTS This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs (P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs (P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs (P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs (P < .0001). A machine learning-based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis. CONCLUSIONS Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.
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18
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In Vitro Time-Kill of Common Ocular Pathogens with Besifloxacin Alone and in Combination with Benzalkonium Chloride. Pharmaceuticals (Basel) 2021; 14:ph14060517. [PMID: 34072129 PMCID: PMC8227847 DOI: 10.3390/ph14060517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Besifloxacin ophthalmic suspension 0.6% (w/v%) contains benzalkonium chloride (BAK) as a preservative. We evaluated the in vitro time-kill activity of besifloxacin, alone and in combination with BAK, against common bacteria implicated in ophthalmic infections. METHODS The activity of besifloxacin (100 µg/mL), BAK (10, 15, 20, and 100 µg/mL), and combinations of besifloxacin and BAK were evaluated against isolates of Staphylococcus epidermidis (n = 4), Staphylococcus aureus (n = 3), Haemophilus influenzae (n = 2), and Pseudomonas aeruginosa (n = 2) in time-kill experiments of 180 min duration. With the exception of one S. aureus isolate, all of the staphylococcal isolates were methicillin- and/or ciprofloxacin-resistant; one P. aeruginosa isolate was ciprofloxacin-resistant. The reductions in the viable colony counts (log10 CFU/mL) were plotted against time, and the differences among the time-kill curves were evaluated using an analysis of variance. Areas-under-the-killing-curve (AUKCs) were also computed. RESULTS Besifloxacin alone demonstrated ≥3-log killing of P. aeruginosa (<5 min) and H. influenzae (<120 min), and approached 3-log kills of S. aureus. BAK alone demonstrated concentration-dependent killing of S. epidermidis, S. aureus and H. influenzae, and at 100 µg/mL produced ≥3-log kills in <5 min against these species. The addition of BAK (10, 15, and 20 µg/mL) to besifloxacin increased the rate of killing compared to besifloxacin alone, with earlier 3-log kills of all species except P. aeruginosa and a variable impact on S. aureus. The greatest reductions in AUKC were observed among H. influenzae (8-fold) and S. epidermidis (≥5-fold). Similar results were found when the isolates were evaluated individually by their resistance phenotype. CONCLUSIONS In addition to confirming the activity of 100 µg/mL BAK as a preservative in the bottle, these data suggest that BAK may help besifloxacin to achieve faster time-kills on-eye in the immediate timeframe post-instillation before extensive dilution against bacterial species implicated in ophthalmic infections, including drug-resistant S. epidermidis. Greater killing activity may help prevent resistance development and/or help treat resistant organisms.
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You IC, Lee SB, Seo KY, Kim MK, Yoon KC, Koh JW, Lee JE, Kim SJ. Clinical Features and Antibiotic Susceptibility of Culture-proven Infectious Keratitis: a Multicenter 10-year Study. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.4.447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Stapleton F. Contact lens‐related corneal infection in Australia. Clin Exp Optom 2021; 103:408-417. [DOI: 10.1111/cxo.13082] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
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21
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Antimicrobial nanomedicine for ocular bacterial and fungal infection. Drug Deliv Transl Res 2021; 11:1352-1375. [PMID: 33840082 DOI: 10.1007/s13346-021-00966-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Ocular infection induced by bacteria and fungi is a major cause of visual impairment and blindness. Topical administration of antibiotics remains the first-line treatment, as effective eradication of pathogens is the core of the anti-infection strategy. Whereas, eye drops lack efficiency and have relatively low bioavailability. Intraocular injection may cause concurrent ocular damage and secondary infection. In addition, antibiotic-based management can be limited by the low sensitivity to multidrug-resistant bacteria. Nanomedicine is proposed as a prospective, effective, and noninvasive platform to mediate ocular delivery and combat pathogen or even resistant strains. Nanomedicine can not only carry antimicrobial agents to fight against pathogens but also directly active microbicidal capability, killing pathogens. More importantly, by modification, nanomedicine can achieve enhanced residence time and release time on the cornea, and easy penetration through corneal tissues into anterior and posterior segments of the eye, thus improving the therapeutic effect for ocular infection. In this review, several categories of antimicrobial nanomedicine are systematically discussed, where the efficiency and possibility of further embellishment and improvement to adapt to clinical use are also investigated. All in all, novel antimicrobial nanomedicine provides potent and prospective ways to manage severe and refractory ocular infections.
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22
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Tummanapalli SS, Willcox MD. Antimicrobial resistance of ocular microbes and the role of antimicrobial peptides. Clin Exp Optom 2021; 104:295-307. [PMID: 32924208 DOI: 10.1111/cxo.13125] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Isolation of antimicrobial-resistant microbes from ocular infections may be becoming more frequent. Infections caused by these microbes can be difficult to treat and lead to poor outcomes. However, new therapies are being developed which may help improve clinical outcomes. This review examines recent reports on the isolation of antibiotic-resistant microbes from ocular infections. In addition, an overview of the development of some new antibiotic therapies is given. The recent literature regarding antibiotic use and resistance, isolation of antibiotic-resistant microbes from ocular infections and the development of potential new antibiotics that can be used to treat these infections was reviewed. Ocular microbial infections are a global public health issue as they can result in vision loss which compromises quality of life. Approximately 70 per cent of ocular infections are caused by bacteria including Chlamydia trachomatis, Staphylococcus aureus, and Pseudomonas aeruginosa and fungi such as Candida albicans, Aspergillus spp. and Fusarium spp. Resistance to first-line antibiotics such as fluoroquinolones and azoles has increased, with resistance of S. aureus isolates from the USA to fluoroquinolones reaching 32 per cent of isolates and 35 per cent being methicillin-resistant (MRSA). Lower levels of MRSA (seven per cent) were isolated by an Australian study. Antimicrobial peptides, which are broad-spectrum alternatives to antibiotics, have been tested as possible new drugs. Several have shown promise in animal models of keratitis, especially treating P. aeruginosa, S. aureus or C. albicans infections. Reports of increasing resistance of ocular isolates to mainstay antibiotics are a concern, and there is evidence that for ocular surface disease this resistance translates into worse clinical outcomes. New antibiotics are being developed, but not by large pharmaceutical companies and mostly in university research laboratories and smaller biotech companies. Antimicrobial peptides show promise in treating keratitis.
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Affiliation(s)
| | - Mark Dp Willcox
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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23
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Lee JW, Somerville T, Kaye SB, Romano V. Staphylococcus aureus Keratitis: Incidence, Pathophysiology, Risk Factors and Novel Strategies for Treatment. J Clin Med 2021; 10:jcm10040758. [PMID: 33668633 PMCID: PMC7918096 DOI: 10.3390/jcm10040758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
Bacterial keratitis is a devastating condition that can rapidly progress to serious complications if not treated promptly. Certain causative microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa are notorious for their resistance to antibiotics. Resistant bacterial keratitis results in poorer outcomes such as scarring and the need for surgical intervention. Thorough understanding of the causative pathogen and its virulence factors is vital for the discovery of novel treatments to avoid further antibiotic resistance. While much has been previously reported on P. aeruginosa, S. aureus has been less extensively studied. This review aims to give a brief overview of S. aureus epidemiology, pathophysiology and clinical characteristics as well as summarise the current evidence for potential novel therapies.
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Affiliation(s)
- Jason W. Lee
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK;
| | - Tobi Somerville
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Stephen B. Kaye
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
- Correspondence:
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Infectious keratitis: trends in microbiological and antibiotic sensitivity patterns. Eye (Lond) 2021; 35:3110-3115. [PMID: 33469134 DOI: 10.1038/s41433-020-01378-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To report the spectrum and trends of isolated microorganisms and their antibiotic susceptibility profile in patients with infectious keratitis in a 6-year period at a referral centre in Tehran. METHODS The microbiology records of all corneal scrapings with a diagnosis of infectious keratitis were reviewed. RESULTS A total of 6282 corneal scrapings were performed during the study period, of which 2479 (39.5%) samples were culture positive. Pseudomonas aeruginosa was found to be the most common causative agent in patients with keratitis, although Streptococcus pneumonia was the most prevalently isolated microorganism in patients older than 50 years. Fusarium sp. was the most common responsible pathogen in patients with fungal keratitis. The prevalence of bacterial keratitis due to gram positive microorganisms increased over time, however the number of Pseudomonas keratitis decreased in the second half of the study. Gram negative organisms showed a good sensitivity to levofloxacin, however, 34.1% of S. aureus isolates and 29.7% of coagulase negative staphylococci were resistant to this antibiotic. The odds of ciprofloxacin and levofloxacin resistance increased 1.25 and 1.15 for each 1-year increase in culture date, respectively (P < 0.001, P = 0.004). CONCLUSIONS We documented an increasing trend in the percentage of gram positive bacteria. Levofloxacin monotherapy might still be a good option in patients with gram negative bacterial keratitis, however owing to increasing resistance of staphylococci to fluoroquinolones, a regimen consisting of a combination of fortified antibiotics may be more effective in staphylococcal keratitis.
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Shrestha GS, Vijay AK, Stapleton F, Henriquez FL, Carnt N. Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis. Cont Lens Anterior Eye 2020; 44:3-13. [PMID: 33303356 DOI: 10.1016/j.clae.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.
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Affiliation(s)
| | | | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona L Henriquez
- School of Health and Life Sciences, The University of the West of Scotland, United Kingdom
| | - Nicole Carnt
- School of Optometry and Vision Science, UNSW Sydney, Australia; Westmead Institute for Medical Research, University of Sydney, Australia; Institute of Ophthalmology, University College London, United Kingdom
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Koh YY, Sun CC, Hsiao CH. Epidemiology and the Estimated Burden of Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based Study. Am J Ophthalmol 2020; 220:152-159. [PMID: 32707204 DOI: 10.1016/j.ajo.2020.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the epidemiologic characteristics of microbial keratitis and its overall burden on the health care system in Taiwan. DESIGN Retrospective, population-based study. METHODS We conducted a study using claims data in the Taiwan National Health Insurance Research Database in 2000-2013, employing diagnoses, drugs, and procedure codes to define diseases and procedures. Participants were classified into groups according to the requirement of hospitalization and surgical intervention. The main outcome measures were incidence, risk factors, predictive factors for hospitalization and surgical intervention, and health care expenditure. RESULTS A total of 2,071 patients were included. The overall incidence significantly increased from 8.4 in 2000 to 20.2 per 100,000 person-years in 2013. The peak age range of incidence was between 18 and 40 years, but the peak age group for health care expenditures was those older than 65 years. A total of 704 patients (33.99%) had analyzable risk factors, of which the top 3 were diabetes mellitus (DM, 11.52%), eye trauma (10.55%), and dry eye (8.72%). Older patients, those using steroid and antiglaucoma agents, and those with ocular and systemic diseases were susceptible to further hospitalization and surgical intervention for the treatment of microbial keratitis. CONCLUSIONS In Taiwan, DM, eye trauma, and dry eye were key predisposing factors for microbial keratitis. Older patients (>40 years) accounted for approximately 80% of health care expenditure for the management of infectious keratitis. Special care may be required for older patients with medication-related risk factors and ocular and systemic comorbidities because they are likely to have severe diseases leading to hospitalization and surgical interventions.
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Affiliation(s)
- Yeo-Yang Koh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
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Jonker SMR, Berendschot TTJM, Saelens IEY, Bauer NJC, Nuijts RMMA. Phakic intraocular lenses: An overview. Indian J Ophthalmol 2020; 68:2779-2796. [PMID: 33229653 PMCID: PMC7856940 DOI: 10.4103/ijo.ijo_2995_20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.
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Affiliation(s)
- Soraya M R Jonker
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Noël J C Bauer
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
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Davletshina NI, Samoylov AN. [Epidemiology and treatment of fungal keratitis]. Vestn Oftalmol 2020; 136:138-145. [PMID: 32779468 DOI: 10.17116/oftalma2020136041138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infectious keratitis in most cases is caused by bacterial, viral or fungal agents, but their structure is changing. Some researchers have noted a substantial increase in fungal corneal lesions in recent decades, but important local etiological therapy remains unavailable in developing countries. While bacterial keratitis and ophthalmoherpes are controlled by widely available local etiotropic therapy, treatment of keratomycosis in the Russian Federation is carried out with off-label medicine. Lack of skills and availability of diagnostic methods and official etiotropic therapy creates unequal conditions for ophthalmology specialists in the fight against ophthalmomycosis. In part, this causes a reduced level of «myco-caution», which leads to long-term ineffective treatment using antibacterial drops, lasting suffering of patients, and results in the loss of the eye functionally and - in some cases - anatomically. Therefore, the study of fungal keratitis remains relevant. The article provides an overview of research data on current epidemiology in different regions of the world, analyzes available antifungal drugs and the prospects for development of affordable and effective treatment of fungal keratitis.
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Affiliation(s)
- N I Davletshina
- Kazan State Medical University, Kazan, Russia.,Republican Clinical Ophthalmological Hospital, Kazan, Russia
| | - A N Samoylov
- Kazan State Medical University, Kazan, Russia.,Republican Clinical Ophthalmological Hospital, Kazan, Russia
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Hung N, Yeh LK, Ma DHK, Lin HC, Tan HY, Chen HC, Sun PL, Hsiao CH. Filamentous Fungal Keratitis in Taiwan: Based on Molecular Diagnosis. Transl Vis Sci Technol 2020; 9:32. [PMID: 32855878 PMCID: PMC7422771 DOI: 10.1167/tvst.9.8.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose To analyze the epidemiological pattern, demographics, risk factors, and treatment outcomes of filamentous fungal keratitis at a tertiary hospital in Taiwan. Methods We recruited 65 patients (65 eyes) with culture-proven filamentous fungal keratitis who received diagnosis and treatment at Chang Gung Memorial Hospital between 2015 and 2018. All isolates were examined through conventional morphological identification and subjected to molecular identification with internal transcribed spacer sequencing. Data on patient demographics, predisposing factors, and treatment outcomes were collected. Results In total, filamentous fungi belonged to 16 genera were identified. Fusarium spp. (29 cases [44.6%]) was the most commonly isolated organism overall, followed by Colletotrichum spp. and Purpureocillium linacinum (seven cases [10.8% for each]), and Aspergillus spp. (six cases [9.2%]). Some fungi that have not been regarded as human pathogens were also identified, such as Paracremonium and Phellinum. Among 52 (80%) patients with predisposing factors, 30 (46.2%) had trauma. The ulcers of 33 (50.8%) patients resolved with medical treatment only. Additionally, six patients (9.2%) had corneal perforation, and nine patients (13.9%) required therapeutic/destructive surgical interventions including therapeutic penetrating keratoplasty (seven patients) or evisceration (two patients). Only 16 patients (24.6%) had final visual acuity of 20/40 or better. Conclusions Through molecular diagnosis, a high diversity of fungal pathogens was revealed along with an increasing incidence of Colletotrichumspp. and Purpureocilliumspp. in Taiwan. The most common risk factor for filamentous fungal keratitis was trauma. The visual outcomes were guarded. Translational Relevance The molecular diagnosis provides insight into accurate identification, which affects the epidemiology and diversity of pathogens of filamentous fungal keratitis.
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Affiliation(s)
- Ning Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Chiung Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Lun Sun
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen CA, Hsu SL, Hsiao CH, Ma DHK, Sun CC, Yu HJ, Fang PC, Kuo MT. Comparison of fungal and bacterial keratitis between tropical and subtropical Taiwan: a prospective cohort study. Ann Clin Microbiol Antimicrob 2020; 19:11. [PMID: 32228660 PMCID: PMC7104486 DOI: 10.1186/s12941-020-00353-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/13/2020] [Indexed: 02/08/2023] Open
Abstract
Background Fungal keratitis (FK) has been shown to be a climate-sensitive disease. The differentiation between FK from bacterial keratitis (BK) was difficult. The purpose of this study was to compare the bacteriology and mycology between tropical and subtropical Taiwan and to investigate the independent risk factors for identification of fungi from bacteria. Methods Two hundred ninety-seven patients with clinical suspected microbial keratitis were prospectively enrolled. A fungal to bacteria rate (FBR), the number of fungi divided by bacteria identified, was determined to estimate the prevalence of fungi and bacteria. Clinical presentation, profiles of microorganisms, and predisposing risk factors were determined. Univariate and multivariate logistic regression analysis were used to investigate the independent risk factors. Results A total of 82 fungi and 143 bacteria were laboratory confirmed. The identification rate of fungus was higher in tropical Taiwan (p = 0.010). Among the fungi and bacteria confirmed, the FBR was 0.29 (22.4% vs. 77.6%) in subtropical Taiwan, and 0.70 (41.3% vs. 58.7%) in tropical Taiwan. Samples obtained in tropical area (p = 0.019), ocular trauma (p = 0.019), and plant exposure (p = 0.003) were independent risk factors for identification of fungus from bacteria. The predominant fungus isolated from corneal scraping were Fusarium solani (25%) and Trichosporon faecale (25%) in subtropical Taiwan; in tropical Taiwan was Fusarium spp. (50%). Conclusions The identification rate of fungus was higher in tropical Taiwan than subtropical Taiwan. Awareness of the local epidemiology is crucial for early diagnosis of fungal keratitis in tropical area.
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Affiliation(s)
- Chih-An Chen
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung and Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
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Egrilmez S, Yildirim-Theveny Ş. Treatment-Resistant Bacterial Keratitis: Challenges and Solutions. Clin Ophthalmol 2020; 14:287-297. [PMID: 32099313 PMCID: PMC6996220 DOI: 10.2147/opth.s181997] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
Bacterial keratitis is an important ophthalmic emergency and one of the most common causes of corneal blindness. The main causes of treatment resistance in bacterial keratitis are failure to eliminate predisposing factors, misdiagnosis and mistreatment. At first, exogenous, local and systemic predisposing factors that disturbing ocular surface must be eliminated to improve corneal ulcers and to prevent recurrences. Smears and scrapings for staining and culture are indispensable diagnostic tools for cases of sight-threatening keratitis (centrally located, multifocal, characterized by melting, painful). Main treatment agents in bacterial keratitis treatment are topical antibiotics. Until the results of culture antibiograms reach the ophthalmologist, empirical antibiotic selections based on direct microscopic examination and gram stain findings are the most appropriate initial treatment approach currently. S. aureus and coagulase-negative staphylococci (CoNS), the most common gram-positive agents, have resistance rates of more than 30% for fluoroquinolone and methicillin. Multidrug resistance rates are similarly high in these microorganisms. P. aeruginosa is the most common gram-negative micro-organism, in case of multidrug-resistant isolates, both functional and anatomical prognosis of the eyes are very poor. In cases of sight-threatening and resistant keratitis, antibiotic susceptibility testing containing imipenem, colistin, and linezolid is seeming to be an important requirement. Despite its efficiency limited to superficial cases, a nonpharmaceutical anti-infective treatment option such as corneal crosslinking for bacterial keratitis is an emerging hope, while antibiotic resistance increases. ![]()
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Antibiotics and Microbial Keratitis: Do We Need to Test for Resistance? Eye Contact Lens 2020; 46:1-2. [DOI: 10.1097/icl.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim D, Cho CH, Lee SB. Clinical Analysis of Bacterial Keratitis According to Culture Positivity. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.11.1027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Doyeon Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Chan Ho Cho
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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