title: Ocular infections caused by non-tuberculous mycobacteria: update on epidemiology and management.
abstract: BACKGROUND
  To provide an update on the frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria.
  
  
  METHODS
  Retrospective study of university clinic patients.
  
  
  METHODS
  One hundred thirty-nine patients with culture confirmed non-tuberculous mycobacteria infections seen at Bascom Palmer Eye Institute from January 1980 to July 2007.
  
  
  METHODS
  Chart review of data collected included patients' demographics, risk factors, microbiological profiles and clinical outcomes.
  
  
  METHODS
  Frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria.
  
  
  RESULTS
  A total of 183 non-tuberculous mycobacteria isolates from 142 eyes were identified, with a fourfold increase in the number of eyes infected with non-tuberculous mycobacteria from 1980-1989 (13.4%) to 2000-2007 (56.3%). Eighty-three percent of non-tuberculous mycobacteria isolates were identified as M. abscessus/chelonae. The majority (91%) of isolates were recovered within 10 days. Common diagnoses included keratitis (36.6%), scleral buckle infections (14.8%) and socket/implant infections (14.8%). Identifiable risk factors were presence of biomaterials (63.1%), ocular surgery (24.1%) and steroid exposure (77%). The median time from diagnosis of culture positive non-tuberculous mycobacteria infection to resolution was 13 to 24 weeks. Combination therapy was used to treat 80% of infected eyes. In vitro susceptibility of non-tuberculous mycobacteria isolates were: amikacin, 81%; clarithromycin, 93%; and moxifloxacin, 21%.
  
  
  CONCLUSIONS
  The incidence of ocular infections caused by non-tuberculous mycobacteria has increased within the last 8 years, with a high number of biomaterial associated infections among this group. Clinical diagnosis and microbiological confirmation of non-tuberculous mycobacteria infections remains challenging. Patient outcomes may be improved by early diagnosis, appropriate therapy and removal of biomaterials.
authors: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 N.W. 17th Street, Miami, FL 33136, USA. dmiller@med.miami.edu
authors: Dalia O
authors: DO
authors: Girgis
authors: Carol L
authors: CL
authors: Karp
authors: Darlene
authors: D
authors: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D005431:Florida / Q000453:epidemiology; D024841:Fluoroquinolones; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D000077266:Moxifloxacin; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D013508:Ophthalmologic Surgical Procedures; D011804:Quinolines / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000583:Amikacin; D017291:Clarithromycin; D000077266:Moxifloxacin