Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers.
OBJECTIVE
To assess age-related risk factors (RFs), microbiologic profile, and prognosis of infectious keratitis and create guidelines for prevention and treatment.


METHODS
Retrospective review of patients with infectious keratitis admitted to 2 Dutch tertiary referral centers from January 2002 to December 2004.


RESULTS
Forty-nine patients were admitted to the Academic Medical Center (Amsterdam) and 107 to the Rotterdam Eye Hospital. Mean age was 56.6 +/- 24.4 (SD) years; 49.4% were >or=60 years of age. The most common RFs among the elderly were systemic illness (36.4%), ocular surgery (33.8%), topical steroids (26%), blepharitis (20.8%), and herpetic eye disease (28.6%). This was significantly different from the most common RFs among younger patients (contact lens wear, 62.7%; chi2, P = 0.000). Gram-negative infections predominated (52.3%) and were more prevalent among younger patients (chi2, P = 0.000). Gram-positive infections prevailed among the elderly. Untreated patients had higher culture positive rates (68.7%) than patients treated with antibiotics before culturing (41.3%; chi2, P = 0.001). Elderly patients had a higher risk of perforations than younger patients (27.6% vs. 9.9%), a worse prognosis (mean VA, 6/30 vs. 6/10), and more often needed surgery (57.1% vs. 23.4%; P < 0.005 in all cases).


CONCLUSIONS
Infectious keratitis is a more severe disease in elderly than in younger patients with more complications and a worse prognosis. Elderly patients have multiple and more diverse risk factors, making prevention difficult. Prevention should aim at minimizing topical steroid use and controlling blepharitis, ocular surface disease, and herpetic eye disease. Initial antibiotic treatment should include sufficient coverage of Gram-positive pathogens.
van der Meulen
Ivanka J
IJ
Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands. i.j.vandermeulen@amc.uva.nl
van Rooij
Jeroen
J
Nieuwendaal
Carla P
CP
Van Cleijnenbreugel
Hugo
H
Geerards
Annette J
AJ
Remeijer
Lies
L
D000328:Adult; D000375:Aging / Q000502:physiology*; D001431:Bacteriological Techniques; D003320:Corneal Ulcer / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons