title: Association between cytotoxic and invasive Pseudomonas aeruginosa and clinical outcomes in bacterial keratitis.
abstract: OBJECTIVE
  To determine whether cytotoxic and invasive Pseudomonas aeruginosa strains differentially influence clinical presentation, outcomes, or therapeutic response in bacterial keratitis.
  
  
  METHODS
  Pseudomonas aeruginosa isolates from the National Eye Institute-funded Steroids for Corneal Ulcers Trial were subtyped as cytotoxic or invasive strains. The main outcome measure compared between the 2 subtypes was change in visual acuity at 3 months using Huber robust regression, adjusting for topical corticosteroid treatment.
  
  
  RESULTS
  Of 101 confirmed P aeruginosa isolates from the Steroids for Corneal Ulcers Trial, 74 had a classically cytotoxic or invasive genotype. While corneal ulcers caused by genotypically invasive P aeruginosa strains were associated at presentation with significantly better visual acuity than corneal ulcers caused by genotypically cytotoxic P aeruginosa strains when adjusting for the effect of ulcer location (P= .008), invasive ulcers had improved significantly less than cytotoxic ulcers at 3 months (0.35; 95% CI, 0.04-0.66 logMAR; P= .03 [3.5-line difference]). Compared with topical moxifloxacin alone, adjunctive treatment with topical corticosteroids was associated with significantly more improvement in visual acuity in the invasive subgroup (P= .04) but was associated with less improvement in visual acuity in the cytotoxic subgroup (P= .07).
  
  
  CONCLUSIONS
  Rational profiling of differentially expressed virulence determinants (eg, cytotoxicity and invasiveness for P aeruginosa) could be used as a tool for decision making in the management of infections to optimize outcomes.
authors: F. I. Proctor Foundation, University of California, San Francisco, San Francisco, CA 94143-0412, USA.
authors: Durga S
authors: DS
authors: Borkar
authors: Suzanne M J
authors: SM
authors: Fleiszig
authors: Chelsia
authors: C
authors: Leong
authors: Prajna
authors: P
authors: Lalitha
authors: Muthiah
authors: M
authors: Srinivasan
authors: Avanti A
authors: AA
authors: Ghanekar
authors: Connie
authors: C
authors: Tam
authors: Wing Y
authors: WY
authors: Li
authors: Michael E
authors: ME
authors: Zegans
authors: Stephen D
authors: SD
authors: McLeod
authors: Thomas M
authors: TM
authors: Lietman
authors: Nisha R
authors: NR
authors: Acharya
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000235:genetics; D015373:Bacterial Typing Techniques; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D005098:Exotoxins / Q000502:physiology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D024841:Fluoroquinolones; D005838:Genotype; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008875:Middle Aged; D000077266:Moxifloxacin; D016133:Polymerase Chain Reaction; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000472:pathogenicity* / Q000502:physiology; D011804:Quinolines / Q000627:therapeutic use; D014774:Virulence / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000890:Anti-Infective Agents; D001372:Aza Compounds; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D005098:Exotoxins; D024841:Fluoroquinolones; D005938:Glucocorticoids; D011804:Quinolines; D007770:L-Lactate Dehydrogenase; D000077266:Moxifloxacin