Changing referral patterns of infectious corneal ulcers to a tertiary care facility in south India - 7-year analysis.
OBJECTIVE
To report changing trends in referral patterns of microbial keratitis evidenced by laboratory results of culture-positive cases from a tertiary eye-care hospital in south India.


METHODS
All patients presenting with microbial (nonviral) keratitis to the cornea services of Aravind Eye Hospital from 2003 to 2009 were identified from a computerized database. Microbiologic characteristics were recorded and annual distributions of causative organisms over the 7-year study period were compared.


RESULTS
Out of a total of 3059 cases of presumed microbial keratitis, 1756 had positive cultures (57.4%). Among the culture-positive cases, fungal pathogens were isolated from 1224 cases (70%), 488 (27.7%) showed bacterial growth, 18 (1.03%) grew acanthamoeba species and 26 (1.5%) demonstrated mixed bacterial and fungal growth. The percentage of fungal isolates in culture-positive cases increased gradually over the study period from 59% in 2004 to 78% in 2009. This increase in frequency of fungal keratitis was statistically significant (P = 0.023). A proportionally decreasing trend was seen in the number of bacterial isolates ranging from 31% in 2003-2005 to 22% in 2009 (P = 0.04).


CONCLUSIONS
An incremental increase was seen in the number of fungal keratitis cases referred to our institute during the study period. Bacterial keratitis showed a decline. This disconcerting trend may lead to an increase in the incidence of corneal blindness in the developing world and thus warrants further research.
Department of Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. drsunny1980@gmail.com
Sabyasachi
S
Sengupta
Krishnan
K
Thiruvengadakrishnan
Ravilla D
RD
Ravindran
Manivasagam C
MC
Vaitilingam
D001419:Bacteria / Q000302:isolation & purification; D003320:Corneal Ulcer / Q000453:epidemiology* / Q000382:microbiology; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D012017:Referral and Consultation / Q000639:trends*; D012424:Rural Population; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data