title: Clinical and Microbiological Profile of Bacterial Microbial Keratitis in a Portuguese Tertiary Referral Center-Where Are We in 2015?
abstract: OBJECTIVE
  To study the microbial profile, antibiotic susceptibility pattern, risk factors, therapeutic trends, and clinical outcomes for microbial keratitis (MK) in a tertiary health care center.
  
  
  METHODS
  All cases with suspected bacterial keratitis that were followed at consultation from September 2007 to August 2015 were included. Microbial cultures were obtained and patients were managed following an internal protocol.
  
  
  RESULTS
  Two hundred thirty-five patients were included, with a mean age of 50.01±20.73 years. We obtained a 38.4% culture-positive rate, with higher proportion of gram-positives (70.8%). The commonest agents were Staphylococcus aureus (23.1%), Corynebacterium macginleyi (20.0%), and Pseudomonas aeruginosa (13.8%). Fluoroquinolone susceptibility was 97%, with no trend toward its decrease. A total of 95.7% had local risk factors, being trauma and contact lens wear the most common (28.9% each), with different age and pathogens distributions (P<0.001). Topical fluoroquinolones were first-line treatment in 99%, in association with aminoglycosides in 81.6%. Good initial response was registered in 95.9%, but 4.1% needed to step up treatment to fortified antibiotics, mainly if Pseudomonas (P=0.021). Good outcome was achieved in 81.8%, negatively affected by exposure and herpetic keratitis (P<0.001), central location (P=0.01), presence of Tyndall (P<0.001), corneal edema (P<0.001), and worse initial best-corrected visual acuity (P<0.001), but not Pseudomonas isolate (P=0.724).
  
  
  CONCLUSIONS
  Gram-positives are the most frequent pathogens and shifting trends in the isolate distribution or emergence of resistant strains were not demonstrated. The susceptibility to first-line antibiotic agents remained high. We suggest a more aggressive approach to P. aeruginosa cases or MK presenting with poor outcome variables.
authors.affiliation: Department of Ophthalmology (C.S.F., L.F., N.M.-G., R.M., L.T., F.F.-R.), Centro Hospitalar de São João, Porto, Portugal; Department of Pharmacology and Therapeutics (L.F.), Faculty of Medicine of University of Porto, Porto, Portugal; and Department of Sense Organs (L.T., F.F.-R.), Faculty of Medicine of University of Porto, Porto, Portugal.
authors.forename: Carla Sofia
authors.initials: CS
authors.lastname: Ferreira
authors.forename: Luis
authors.initials: L
authors.lastname: Figueira
authors.forename: Nuno
authors.initials: N
authors.lastname: Moreira-Gonçalves
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreira
authors.forename: Luis
authors.initials: L
authors.lastname: Torrão
authors.forename: Fernando
authors.initials: F
authors.lastname: Falcão-Reis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D003315:Cornea / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007634:Keratitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents