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Bacterial susceptibility to topical antimicrobials and clinical outcome in bacterial keratitis.
Invest Ophthalmol Vis Sci. 2010 Jan; 51(1):362-8.IO

Abstract

PURPOSE

To investigate the relationship between the susceptibility of bacteria to topical antimicrobials and clinical outcome in microbial keratitis.

METHODS

Clinical outcome data were collected from patients with microbial keratitis from whom a bacterium had been isolated during the period 2003 to 2006. The minimum inhibitory concentration (MIC) was determined for the isolates against 10 antimicrobials. The determinants of the primary clinical outcome, the ratio of healing time (closure of epithelial defect) to ulcer size (HT/UA), was analyzed in a general linear model.

RESULTS

Complete clinical outcome and MIC data were available for 421 patients. Sixteen (4%) patients required enucleation and 23 (5%) surgical treatment; in 382 (91%) the ulcer healed with intensive topical antimicrobial therapy. There were significant correlations between HT/UA and organism type (P = 0.001), nearest distance of the ulcer to the limbus (0.02), and MIC of the first antimicrobial used or lowest MIC of combined therapy (P = 0.006). In a model including patients who received monotherapy with a fluoroquinolone who had no subsequent change in their treatment and whose ulcers healed without surgical intervention, there were significant linear associations between clinical outcome and MIC for Pseudomonas spp. (P = 0.047), Staphylococcus aureus (P = 0.04), and Enterobacteriaceae (P = 0.045), but not for Streptococcus spp. (P = 0.85) and coagulase-negative staphylococci (CNS) (P = 0.88).

CONCLUSION

With fluoroquinolone monotherapy, there was significant association between the MIC of the antimicrobial prescribed and the clinical outcome with all bacteria except CNS and Streptococcus spp. The approach used in this study, if used prospectively, could allow topical breakpoint susceptibility concentrations to be determined for individual antimicrobial and bacterial combinations.

Authors+Show Affiliations

Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, United Kingdom. s.b.kaye@liverpool.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

19684005

Citation

Kaye, Stephen, et al. "Bacterial Susceptibility to Topical Antimicrobials and Clinical Outcome in Bacterial Keratitis." Investigative Ophthalmology & Visual Science, vol. 51, no. 1, 2010, pp. 362-8.
Kaye S, Tuft S, Neal T, et al. Bacterial susceptibility to topical antimicrobials and clinical outcome in bacterial keratitis. Invest Ophthalmol Vis Sci. 2010;51(1):362-8.
Kaye, S., Tuft, S., Neal, T., Tole, D., Leeming, J., Figueiredo, F., Armstrong, M., McDonnell, P., Tullo, A., & Parry, C. (2010). Bacterial susceptibility to topical antimicrobials and clinical outcome in bacterial keratitis. Investigative Ophthalmology & Visual Science, 51(1), 362-8. https://doi.org/10.1167/iovs.09-3933
Kaye S, et al. Bacterial Susceptibility to Topical Antimicrobials and Clinical Outcome in Bacterial Keratitis. Invest Ophthalmol Vis Sci. 2010;51(1):362-8. PubMed PMID: 19684005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bacterial susceptibility to topical antimicrobials and clinical outcome in bacterial keratitis. AU - Kaye,Stephen, AU - Tuft,Stephen, AU - Neal,Timothy, AU - Tole,Derek, AU - Leeming,John, AU - Figueiredo,Francisco, AU - Armstrong,Malcolm, AU - McDonnell,Peter, AU - Tullo,Andrew, AU - Parry,Christopher, Y1 - 2009/08/13/ PY - 2009/8/18/entrez PY - 2009/8/18/pubmed PY - 2010/2/4/medline SP - 362 EP - 8 JF - Investigative ophthalmology & visual science JO - Invest Ophthalmol Vis Sci VL - 51 IS - 1 N2 - PURPOSE: To investigate the relationship between the susceptibility of bacteria to topical antimicrobials and clinical outcome in microbial keratitis. METHODS: Clinical outcome data were collected from patients with microbial keratitis from whom a bacterium had been isolated during the period 2003 to 2006. The minimum inhibitory concentration (MIC) was determined for the isolates against 10 antimicrobials. The determinants of the primary clinical outcome, the ratio of healing time (closure of epithelial defect) to ulcer size (HT/UA), was analyzed in a general linear model. RESULTS: Complete clinical outcome and MIC data were available for 421 patients. Sixteen (4%) patients required enucleation and 23 (5%) surgical treatment; in 382 (91%) the ulcer healed with intensive topical antimicrobial therapy. There were significant correlations between HT/UA and organism type (P = 0.001), nearest distance of the ulcer to the limbus (0.02), and MIC of the first antimicrobial used or lowest MIC of combined therapy (P = 0.006). In a model including patients who received monotherapy with a fluoroquinolone who had no subsequent change in their treatment and whose ulcers healed without surgical intervention, there were significant linear associations between clinical outcome and MIC for Pseudomonas spp. (P = 0.047), Staphylococcus aureus (P = 0.04), and Enterobacteriaceae (P = 0.045), but not for Streptococcus spp. (P = 0.85) and coagulase-negative staphylococci (CNS) (P = 0.88). CONCLUSION: With fluoroquinolone monotherapy, there was significant association between the MIC of the antimicrobial prescribed and the clinical outcome with all bacteria except CNS and Streptococcus spp. The approach used in this study, if used prospectively, could allow topical breakpoint susceptibility concentrations to be determined for individual antimicrobial and bacterial combinations. SN - 1552-5783 UR - https://www.unboundmedicine.com/medline/citation/19684005/Bacterial_susceptibility_to_topical_antimicrobials_and_clinical_outcome_in_bacterial_keratitis_ L2 - https://iovs.arvojournals.org/article.aspx?doi=10.1167/iovs.09-3933 DB - PRIME DP - Unbound Medicine ER -