title: Multidrug-Resistant Pseudomonas aeruginosa Keratitis: Risk Factors, Clinical Characteristics, and Outcomes.
abstract: OBJECTIVE
  To identify risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) keratitis and to report clinical characteristics and outcomes of this infection.
  
  
  METHODS
  Retrospective, case-control study.
  
  
  METHODS
  Ninety episodes of P. aeruginosa keratitis from a tertiary care eye institution from 2007 through 2014 were identified. Episodes of MDR-PA keratitis were taken as cases. Episodes of drug-sensitive P. aeruginosa keratitis during the same period were taken as controls.
  
  
  METHODS
  Chart review of cases and controls. Multidrug resistance was defined as resistance to 3 or more classes of antimicrobial drugs. Logistic regression analysis was used to determine association of baseline characteristics with multidrug resistance. Clinical characteristics and risk factors in each group also were compared.
  
  
  METHODS
  Risk factors for multidrug resistance, including age, gender, eye, duration of symptoms, topical steroid or lubricant ointment use, trauma, prior ocular surgery, presence of a compromised ocular surface, and bandage contact lens use.
  
  
  RESULTS
  Twenty-three episodes of MDR-PA keratitis (cases) and 67 episodes of drug-sensitive P. aeruginosa keratitis (controls) were identified. In the multivariate analysis, lubricant ointment use, presence of a compromised ocular surface, and bandage contact lens use were associated with MDR-PA keratitis. Antimicrobial resistance in the MDR-PA keratitis isolates was least for colistin and imipenem (56.52% each). Corneal perforation was more common in cases (52.17% [12 of 23]) than in controls (11.94% [8 of 67]; P = 0.0001). Cyanoacrylate glue application was required in 47.82% of cases (11 of 23), compared with 22.38% of controls (15 of 67; P = 0.031). Keratoplasty was more commonly required in cases (47.82% [11 of 23]) than in controls (20.89% [14 of 67]; P = 0.017).
  
  
  CONCLUSIONS
  Lubricant ointment use, a compromised ocular surface, and bandage contact lens use are associated with MDR-PA keratitis. Preservative-free lubricant ointment may act as a source or reservoir of infection. Outcomes are worse in MDR-PA keratitis compared with drug-sensitive P. aeruginosa keratitis.
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India. Electronic address: jayeshvazirani@gmail.com.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Vazirani
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India.
authors.forename: Siva
authors.initials: S
authors.lastname: Wurity
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Md Hasnat
authors.initials: MH
authors.lastname: Ali
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003320:Corneal Ulcer / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D003487:Cyanoacrylates / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D012307:Risk Factors; D014014:Tissue Adhesives / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D003487:Cyanoacrylates; D014014:Tissue Adhesives; C040229:MK 6 cyanoacrylate