title: Triple infection keratitis.
abstract: OBJECTIVE
  To analyze the demographics, risk factors, and clinical and microbiological characteristics of triple infection keratitis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Five patients (five eyes) with triple infection keratitis were identified.
  
  
  METHODS
  Eyes with polymicrobial keratitis were identified from January 2002 to December 2010. Only culture-positive cases and eyes infected by three different organisms were included. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed.
  
  
  METHODS
  The size of the corneal infiltrate, presence of hypopyon, pre- and post-treatment best-corrected visual acuity, antibiotic regimen and sensitivity, types of isolated pathogens, duration of infection, and treatment outcomes.
  
  
  RESULTS
  The mean age was 39 years (SD, ±23.4; range, 21-74). Use of topical steroids was the commonest risk factor (80%). Multiple risk factors were identified in four eyes. The average size of corneal infiltrate was 23.5 mm (SD, ±35.2; range, 2.08-85.5), and all eyes developed hypopyon. A total of 15 organisms belonging to 10 species (bacteria=7, fungi=3) were isolated. Pseudomonas aeruginosa and Candida albicans were the most frequently isolated bacteria (n=3) and fungi (n=3), respectively. All patients had at least one type of fungal isolate. Infection resolved with medical treatment in four eyes and one eye had to be eviscerated as the patient developed panophthalmitis. The average time taken for infection to resolve was 30 days (SD, ±19.3; range, 13-61).
  
  
  CONCLUSIONS
  A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Use of topical steroid was the most common risk factor. Prolonged course of disease, relatively large infiltrate, and presence of hypopyon and fungal isolates are typical features of triple infection keratitis.
authors.affiliation: Department of Ophthalmology (M.R., A.M.T.), National University Health System, Singapore, Singapore; and Yong Loo Lin School of Medicine (M.R., L.C.S.N., A.M.T.), National University of Singapore, National University Health System, Singapore, Singapore.
authors.forename: Manotosh
authors.initials: M
authors.lastname: Ray
authors.forename: Lim Chen Siang
authors.initials: LC
authors.lastname: Nigel
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids