The prevalence and pathogenicity of Propionibacterium acnes keratitis.
OBJECTIVE
To study the prevalence, pathogenicity, and virulence of Propionibacterium acnes keratitis.


METHODS
All cases of infectious keratitis submitted to the microbiologic laboratory of the New York Eye and Ear Infirmary between January 1, 2003, and April 6, 2006, were reviewed. Those cases in which P. acnes was recovered from culture were collected, and the medical records studied in depth.


RESULTS
Of 1555 cultures submitted to the microbiology laboratory, 1329 (85.5%) were positive for growth. One hundred twenty four (9.3%) of the 1329 cases yielded P. acnes in at least 1 culture medium. Seventy eight (62.9%) of 124 cases had not been pretreated with antibiotics before culture, and 66.7% of the nonpretreated ulcers were monomicrobial (P. acnes only). Fifty one (65.4%) of 78 cases of the nonpretreated corneal ulcers presented with a cellular reaction in anterior chamber, 12 (15.4%) with a hypopyon (6 were monomicrobial), 21 (26.9%) had stromal thinning (12 of which were monomicrobial), and 2 (2.6%) progressed to perforation (both polymicrobial). Corneal ulcers associated with P. acnes tended to be small (66.7%) and were widely distributed: central (n = 17, 21.8%), paracentral (n = 44, 56.4%), and peripheral (n = 17, 21.8%). The most common risk factors were contact lens wear and previous history of ocular surgery. Three of the 78 nonpretreated patients were unresponsive to medical treatment and required surgery for keratitis.


CONCLUSIONS
This study provides evidence that P. acnes is a frequent cause of bacterial keratitis and may cause significant morbidity.
Ovodenko
Boris
B
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY 10003, USA.
Seedor
John A
JA
Ritterband
David C
DC
Shah
Mahendra
M
Yang
Renee
R
Koplin
Richard S
RS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003261:Contact Lenses / Q000009:adverse effects; D003320:Corneal Ulcer / Q000453:epidemiology / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007223:Infant; D007634:Keratitis / Q000453:epidemiology* / Q000382:microbiology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D015995:Prevalence; D011425:Propionibacterium acnes / Q000472:pathogenicity*; D055815:Young Adult
D000900:Anti-Bacterial Agents