title: The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic.
abstract: OBJECTIVE
  The purpose of the study is to compare the utility of culturing corneal ulcers in a tertiary referral clinic and a general ophthalmology clinic.
  
  
  METHODS
  A retrospective review of medical and microbiologic records was performed.
  
  
  METHODS
  One hundred fifty-seven patients with corneal ulcers were included in the study. Eighty-two ulcers were treated in the referral clinic and 75 ulcers were treated in the general ophthalmology clinic.
  
  
  METHODS
  The authors determined the percentage of corneal ulcers in each clinical setting that failed to respond to empiric therapy and required a culture-directed change in treatment.
  
  
  RESULTS
  One hundred fifty-seven ulcers were included. Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results. All 75 patients in the general clinic responded to empiric antibiotics, such that culture data never were required for modification of therapy (0%, P = 0.007). In contrast to patients treated in the Cornea Clinic, patients treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulceration other than contact lens wear.
  
  
  CONCLUSIONS
  Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers. However, it appears reasonable for general ophthalmologists to use culturing more judiciously. Patients with significant corneal ulcers should be cultured regardless of the clinic to which they present. However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics. Close follow-up is mandatory to discover the rare patient who will not respond to empiric therapy.
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan, Ann Arbor, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Rodman
authors.forename: S
authors.initials: S
authors.lastname: Spisak
authors.forename: A
authors.initials: A
authors.lastname: Sugar
authors.forename: R F
authors.initials: RF
authors.lastname: Meyer
authors.forename: H K
authors.initials: HK
authors.lastname: Soong
authors.forename: D C
authors.initials: DC
authors.lastname: Musch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D003315:Cornea / Q000187:drug effects / Q000382:microbiology*; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D056890:Eukaryota / Q000302:isolation & purification; D015817:Eye Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008828:Microbiological Techniques / Q000706:statistics & numerical data*; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents