Microbial keratitis predisposing factors and morbidity

Keay, Lisa, Edwards, Katie P., Naduvilath, Thomas, Taylor, Hugh R., Snibson, Grant, Forde, Kevin, & Stapleton, Fiona (2006) Microbial keratitis predisposing factors and morbidity. Ophthalmology, 113(1), pp. 109-116.

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PURPOSE: To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population. DESIGN: Retrospective medical records review. PARTICIPANTS: Fifteen- to 64-year-olds with microbial keratitis treated at the Royal Victorian Eye and Ear Hospital between May 2001 and April 2003 (n = 291). METHODS: Risk factors were identified from patient files. Demographic, clinical, and microbiological data; severity; outpatient visits; hospital bed days; and vision loss were examined. MAIN OUTCOME MEASURES: Cost to treat (Australian dollars), vision loss, and factors influencing these outcomes. RESULTS: Ocular trauma (106/291 [36.4%]) and contact lens (CL) wear (98/291 [33.7%]) were the most commonly identified predisposing factors; 18 (6.1%) had multiple predisposing factors; 17 (5.8%), ocular surface disease; 20 (6.9%), herpetic eye disease; 4 (1.4%), systemic associations; 5 (1.7%), other; and 23 (7.9%), unknown cause. Of trauma cases, 90.6% involved males, compared with 44% to 57% for other groups (P<0.001). Contact lens wearers were younger than the other groups--mean age 30 years, compared with 40 to 47 years (P<0.01). Gram-negative organisms were isolated more frequently in CL wearers than trauma cases (18.7% vs. 6.5%, P = 0.01). The number of outpatient visits was 4+/-1 (median +/- interquartile range), and 19.6% (57/291) were hospitalized for 5+/-2 days. Hospital resource use and vision loss were similar for predisposing factors but differed by causative microorganism. Eighty-eight percent of cases were scraped: acanthamoeba keratitis was the most expensive to treat, followed by fungal and herpetic keratitis and, lastly, culture-proven bacterial keratitis or culture-negative cases (P<0.0001). After treatment, 21.7% exhibited >2 lines of vision loss, and 1.6% of cases had > or =10 lines of vision loss. Vision loss was associated with clinical severity (P = 0.005). CONCLUSIONS: Ocular trauma and CL wear are the major predisposing factors for microbial keratitis in this age range. These cases require significant hospital resources during treatment, and the keratitis may result in loss of vision.

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ID Code: 20550
Item Type: Journal Article
Refereed: Yes
Additional Information: Accession Number: 16360210 Language: English. Date Revised: 20061115. Date Created: 20060103. Date Completed: 20060110. Update Code: 20081217. Publication Type: Journal Article; Research Support, Non-U.S. Gov't. Journal ID: 7802443. Publication Model: Print-Electronic. Cited Medium: Internet. NLM ISO Abbr: Ophthalmology. Comment in: Ophthalmology. 2006 Nov;113(11):2115-6; author reply 2116. (PMID: 17074578).
Keywords: acanthamoeba keratitis epidemiology, corneal ulcer epidemiology, eye infections, bacterial epidemiology, adolescent, adult, contact lenses utilization, eye infections, eye injuries epidemiology, female, health care costs, hospital costs, humans, inpatients, male, middle aged, morbidity, retrospective studies, risk factors
DOI: 10.1016/j.ophtha.2005.08.013
ISSN: 1549-4713
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300)
Divisions: Current > Institutes > Institute of Health and Biomedical Innovation
Deposited On: 20 May 2009 22:49
Last Modified: 10 Aug 2011 17:47

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