title: Pseudomonas aeruginosa keratitis: outcomes and response to corticosteroid treatment.
abstract: OBJECTIVE
  To compare the clinical course and effect of adjunctive corticosteroid therapy in Pseudomonas aeruginosa with those of all other strains of bacterial keratitis.
  
  
  METHODS
  Subanalyses were performed on data collected in the Steroids for Corneal Ulcers Trial (SCUT), a large randomized controlled trial in which patients were treated with moxifloxacin and were randomly assigned to 1 of 2 adjunctive treatment arms: corticosteroid or placebo (4 times a day with subsequent reduction). Multivariate analysis was used to determine the effect of predictors, organism, and treatment on outcomes, 3-month best-spectacle-corrected visual acuity (BSCVA), and infiltrate/scar size. The incidence of adverse events over a 3-month follow-up period was compared using Fisher's exact test.
  
  
  RESULTS
  SCUT enrolled 500 patients. One hundred ten patients had P. aeruginosa ulcers; 99 of 110 (90%) enrolled patients returned for follow-up at 3 months. Patients with P. aeruginosa ulcers had significantly worse visual acuities than patients with other bacterial ulcers (P = 0.001) but showed significantly more improvement in 3-month BSCVA than those with other bacterial ulcers, adjusting for baseline characteristics (-0.14 logMAR; 95% confidence interval, -0.23 to -0.04; P = 0.004). There was no significant difference in adverse events between P. aeruginosa and other bacterial ulcers. There were no significant differences in BSCVA (P = 0.69), infiltrate/scar size (P = 0.17), and incidence of adverse events between patients with P. aeruginosa ulcers treated with adjunctive corticosteroids and patients given placebo.
  
  
  CONCLUSIONS
  Although P. aeruginosa corneal ulcers have a more severe presentation, they appear to respond better to treatment than other bacterial ulcers. The authors did not find a significant benefit with corticosteroid treatment, but they also did not find any increase in adverse events. (ClinicalTrials.gov number, NCT00324168.).
authors.affiliation: F. I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Aileen
authors.initials: A
authors.lastname: Sy
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Jeena
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.forename: Revathi
authors.initials: R
authors.lastname: Rajaraman
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Ravindran
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.forename: David
authors.initials: D
authors.lastname: Glidden
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zegans
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D001372:Aza Compounds / Q000009:adverse effects / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D004311:Double-Blind Method; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D024841:Fluoroquinolones; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D011804:Quinolines / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D005938:Glucocorticoids; D011804:Quinolines; C009022:prednisolone phosphate; D011239:Prednisolone; D000077266:Moxifloxacin