title: Comparison Between Polymicrobial and Fungal Keratitis: Clinical Features, Risk Factors, and Outcome.
abstract: OBJECTIVE
  To compare the clinical features, risk factors, and outcome of polymicrobial keratitis with monomicrobial keratitis due to fungus.
  
  
  METHODS
  Retrospective, comparative interventional case series.
  
  
  METHODS
  Consecutive cases of microbial keratitis with significant growth of more than 1 organism in culture and culture-proven fungal keratitis treated with natamycin alone were retrieved from the microbiology department. Complete success was defined as resolution of the infiltrate with scar formation on medical treatment, partial success as resolution following tissue adhesive application, and failure as inadequate response to medical therapy with increasing infiltrate size, corneal melting, and/or perforation necessitating therapeutic penetrating keratoplasty (PKP) or evisceration.
  
  
  RESULTS
  There were 34 eyes of 34 patients with polymicrobial keratitis and 60 cases of fungal keratitis. Compared to patients with fungal keratitis, patients with polymicrobial keratitis were significantly older (50.03 ± 9.81 years vs 42.79 ± 12.15 years, P = .0038), with larger infiltrates at presentation (61.8% vs 24.1%, P = .0007), a higher association with endophthalmitis (11.8% vs 0%, P = .03), previous history of corneal graft (20.6% vs 0%, P = .0012), and prior topical corticosteroid use (23.5% vs 5%, P = .019). In the polymicrobial group, a combination of bacteria and fungus was more frequently isolated (23, 67.6%), among which filamentous fungi (25, 39.1%) and coagulase-negative staphylococci (14, 21.9%) comprised a majority. Complete success was significantly lower in the polymicrobial group compared to the fungal keratitis group (39.3% vs 73.7%, P = .0045). In multivariate logistic regression analysis comparing factors affecting the outcome between the 2 groups, older age (P = .027) and ulcers larger than 6 mm (P = .001) at presentation adversely affected outcome.
  
  
  CONCLUSIONS
  Polymicrobial keratitis with fungus and bacteria was more common and more challenging to treat, with a poorer outcome than fungal keratitis. Medical treatment may be effective; however, therapeutic PKP provided globe salvage at best. Early PKP may be advocated for larger ulcers at presentation.
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India. Electronic address: merle@lvpei.org.
authors.forename: Merle
authors.initials: M
authors.lastname: Fernandes
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Vira
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India.
authors.forename: Mrinmoy
authors.initials: M
authors.lastname: Dey
authors.affiliation: Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India.
authors.forename: Tanuja
authors.initials: T
authors.lastname: Tanzin
authors.affiliation: Ocular Microbiology Service, L. V. Prasad Eye Institute, Visakhapatnam, India.
authors.forename: Nagendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Savitri
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D003315:Cornea / Q000382:microbiology* / Q000473:pathology; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents