title: The importance of initial management in the treatment of severe infectious corneal ulcers.
abstract: OBJECTIVE
  To identify factors that influence the outcome of patients with severe infectious corneal ulcers.
  
  
  METHODS
  A retrospective review was performed of the hospital records of all such patients admitted to the Doheny Eye Hospital during a 30 month period. Outcome variables examined were change in visual acuity, duration of hospitalization, hospital charges, and percentage of patients who required penetrating keratoplasty.
  
  
  RESULTS
  Sixty-two ulcers were included. An organism was identified and antibiotic sensitivities established in 52 patients (84%). Inpatient therapy involved a combination of fortified aminoglycoside and cephalosporin antibiotics in 39 patients (63%) and was found to be appropriate on the basis of sensitivity studies in 49 (94%) of 52 patients. Inappropriate initial treatment was related to increased hospital charge (P = 0.024) as well as increased risk of penetrating keratoplasty (P = 0.001).
  
  
  CONCLUSIONS
  Appropriate initial therapy is most critical in the course of serious corneal ulcers, and aggressive, broad-spectrum antibiotic coverage is advocated.
authors.affiliation: Doheny Eye Institute, Los Angeles, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: McLeod
authors.forename: L D
authors.initials: LD
authors.lastname: LaBree
authors.forename: R
authors.initials: R
authors.lastname: Tayyanipour
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: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000382:microbiology; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D015818:Eye Infections, Bacterial / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015821:Eye Infections, Fungal / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005658:Fungi / Q000187:drug effects / Q000302:isolation & purification; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents