title: The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis.
abstract: OBJECTIVE
  To examine the role of routine smears, cultures, and antibiotic sensitivity testing in the treatment of suspected infectious keratitis.
  
  
  METHODS
  A retrospective chart and laboratory data review was performed for 81 consecutive patients seen in the Los Angeles County/University of Southern California Department of Ophthalmology between June 1991 and December 1993 with a primary diagnosis of community-acquired infectious keratitis. No patients were treated with antibiotics before evaluation in the author's department, and all underwent corneal scrapings for gram-stain and bacterial, fungal, and mycobacterium cultures. Ulcers were classified as moderate or severe. All initially were treated as inpatients with a regimen including fortified cefazolin and a fortified aminoglycoside.
  
  
  RESULTS
  Of 81 patients, 74 ulcers were either culture- negative (n=18) or grew bacteria (n=56). Fungal infection was suggested in seven patients. Of the nonfungal ulcers, 33 were classified as moderate, and 41 as severe; all moderate ulcers improved without requiring a modification in antibiotic treatment, whereas 3 severe ulcers required a change in treatment.
  
  
  CONCLUSIONS
  Most community-acquired bacterial ulcers resolve with broad spectrum empiric therapy. Alternatives to universal culture and sensitivity testing that might be considered include selectively performing cultures for more severe or suspected non-bacterial ulcers or routinely obtaining cultures in all cases, but pursuing identification and sensitivity studies only when those data are required for therapy modification.
authors.affiliation: Department of Ophthalmology, University of Southern California, Los Angeles, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: McLeod
authors.forename: A
authors.initials: A
authors.lastname: Kolahdouz-Isfahani
authors.forename: K
authors.initials: K
authors.lastname: Rostamian
authors.forename: C W
authors.initials: CW
authors.lastname: Flowers
authors.forename: P P
authors.initials: PP
authors.lastname: Lee
authors.forename: P J
authors.initials: PJ
authors.lastname: McDonnell
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005658:Fungi / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008826:Microbial Sensitivity Tests; D009172:Mycology / Q000379:methods; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents