title: [Diagnostic and therapeutic contribution of microbiological analysis in severe microbial keratitis at Reims University Hospital between 2012 and 2014].
abstract: OBJECTIVE
  To investigate the contribution of microbial analysis in the diagnosis and management of severe microbial keratitis.
  
  
  METHODS
  This is a monocentric retrospective study at the University Hospital of Reims from January 2012 to December 2014. Corneal scrapings with infectious keratitis were subjected to routine bacterial and fungal culture. PCR was also performed to detect various viral DNA (VZV, CMV, EBV, HSV 1 & 2, adenovirus) and Acanthamoeba sp. DNA. All contact lens cases were analyzed if available.
  
  
  RESULTS
  One hundred and six patients were hospitalized, including 30 contact lens wearers (28.3%). Sixty-four bacterial cultures were positive (68%). Twenty-five different bacterial species were identified with a majority of gram-positive bacteria (67.92%). Among contact lens wearers, the initial VA was better than non-wearers (P=0.0004) and 37% of bacteria identified (a plurality) were gram positive. Of 11 contact lens case analyzed, in only one case (3.3%) did the result correlate with the corneal culture. Only 9 samples from the 323 viral DNA extractions and real time PCR were positive (2.8%); 7 were HSV1. No prior antiviral therapy had been started. Fungal culture was positive in 2 of the 97 corneal samples taken and 63.6% of the contact lens cases (7/11 cases). Only one of the 40 Acanthamoeba sp. PCR's was positive.
  
  
  CONCLUSIONS
  The systematic performance of microbiological investigations is a good diagnostic approach given the polymorphism of clinical presentations of corneal ulcers, which can sometimes be extremely misleading. Culture of contact lens cases appears ineffective for the detection and determination of the causative microorganism. The high incidence of Staphylococcus in bacterial keratitis and the prevalence of infections with gram-positive bacteria in contact lens wearers were noted.
authors.affiliation: Service d'ophtalmologie, hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51090 Reims, France. Electronic address: jessycaliot@hotmail.fr.
authors.forename: J
authors.initials: J
authors.lastname: Caliot
authors.affiliation: Service d'ophtalmologie, fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Guindolet
authors.affiliation: Service d'ophtalmologie, hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51090 Reims, France.
authors.forename: A
authors.initials: A
authors.lastname: Ducasse
authors.affiliation: Laboratoire de virologie médicale et moléculaire, faculté de médecine, 51, avenue Cognac-Jay, 51092 Reims cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Andreoletti
authors.affiliation: Service d'ophtalmologie, hôpital Robert-Debré, CHU de Reims, rue du Général-Koenig, 51090 Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Arndt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D015817:Eye Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007634:Keratitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D016533:Mycological Typing Techniques; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014773:Virology / Q000379:methods; D055815:Young Adult
keywords: Abcès; Analyses microbiennes; Bacterial cultures; Contact lens wear; Corneal abscess; Corneal scraping; Cultures bactériennes; Fungal keratitis; Grattage cornéen; Kératite fongique; Kératite infectieuse grave; Microbial analysis; PCR virales; Porteur de lentille de contact; Severe microbial keratitis; Viral PCR