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Seasonal, geographic, and antimicrobial resistance patterns in microbial keratitis: 4-year experience in eastern Pennsylvania.
Cornea 2015; 34(3):296-302C

Abstract

PURPOSE

The aim of this study was to review the demographics, causative organisms, seasonal and geographic variation, and antimicrobial resistance patterns of microbial keratitis at our institution over a 4-year period.

METHODS

Electronic medical records of all patients with microbial keratitis who underwent corneal culturing at a single institution in eastern Pennsylvania between January 1, 2009 and December 31, 2012 were reviewed.

RESULTS

A total of 311 patients representing 323 instances of infectious keratitis were analyzed. The most frequently implicated organisms in contact lens-related infections were Pseudomonas aeruginosa for bacteria and Fusarium species for fungus, compared with Staphylococcus aureus and Candida species in non-contact lens-associated bacterial infections. Bacterial keratitis occurred most frequently in spring and least frequently in winter (P = 0.024). Patients who live in large fringe metro (suburban) areas accounted for the highest proportion of infectious keratitis cases. P. aeruginosa and methicillin-sensitive S. aureus isolates were highly susceptible to fluoroquinolones, whereas 32% of coagulase-negative staphylococcus isolates tested were resistant to moxifloxacin and gatifloxacin, and all methicillin-resistant S. aureus organisms tested were resistant to these 2 fluoroquinolones. No organisms tested were resistant to tobramycin, gentamicin, or vancomycin. No fungal infections tested were resistant to voriconazole.

CONCLUSIONS

Most infectious keratitis occurred in nonwinter months and in patients from suburban counties. Although fluoroquinolones were effective against the most common bacteria, staphylococcal species exhibited a high rate of resistance, representing a therapeutic challenge given the increasing use of fluoroquinolones as first-line monotherapy. No organisms tested were resistant to tobramycin, gentamicin, vancomycin, or voriconazole.

Authors+Show Affiliations

*Wills Eye Hospital, Philadelphia, PA; †Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; ‡Loma Linda University School of Medicine, Loma Linda, CA; §The Warren Alpert Medical School of Brown University, Providence, RI; and ¶The University of Pennsylvania, Philadelphia, PA.No 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25603231

Citation

Ni, Nina, et al. "Seasonal, Geographic, and Antimicrobial Resistance Patterns in Microbial Keratitis: 4-year Experience in Eastern Pennsylvania." Cornea, vol. 34, no. 3, 2015, pp. 296-302.
Ni N, Nam EM, Hammersmith KM, et al. Seasonal, geographic, and antimicrobial resistance patterns in microbial keratitis: 4-year experience in eastern Pennsylvania. Cornea. 2015;34(3):296-302.
Ni, N., Nam, E. M., Hammersmith, K. M., Nagra, P. K., Azari, A. A., Leiby, B. E., ... Rapuano, C. J. (2015). Seasonal, geographic, and antimicrobial resistance patterns in microbial keratitis: 4-year experience in eastern Pennsylvania. Cornea, 34(3), pp. 296-302. doi:10.1097/ICO.0000000000000352.
Ni N, et al. Seasonal, Geographic, and Antimicrobial Resistance Patterns in Microbial Keratitis: 4-year Experience in Eastern Pennsylvania. Cornea. 2015;34(3):296-302. PubMed PMID: 25603231.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Seasonal, geographic, and antimicrobial resistance patterns in microbial keratitis: 4-year experience in eastern Pennsylvania. AU - Ni,Nina, AU - Nam,Enoch M, AU - Hammersmith,Kristin M, AU - Nagra,Parveen K, AU - Azari,Amir A, AU - Leiby,Benjamin E, AU - Dai,Yang, AU - Cabrera,F Abigail, AU - Ma,Jenny F, AU - Lambert,Calvin E,Jr AU - Honig,Stephanie E, AU - Rapuano,Christopher J, PY - 2015/1/21/entrez PY - 2015/1/21/pubmed PY - 2015/9/1/medline SP - 296 EP - 302 JF - Cornea JO - Cornea VL - 34 IS - 3 N2 - PURPOSE: The aim of this study was to review the demographics, causative organisms, seasonal and geographic variation, and antimicrobial resistance patterns of microbial keratitis at our institution over a 4-year period. METHODS: Electronic medical records of all patients with microbial keratitis who underwent corneal culturing at a single institution in eastern Pennsylvania between January 1, 2009 and December 31, 2012 were reviewed. RESULTS: A total of 311 patients representing 323 instances of infectious keratitis were analyzed. The most frequently implicated organisms in contact lens-related infections were Pseudomonas aeruginosa for bacteria and Fusarium species for fungus, compared with Staphylococcus aureus and Candida species in non-contact lens-associated bacterial infections. Bacterial keratitis occurred most frequently in spring and least frequently in winter (P = 0.024). Patients who live in large fringe metro (suburban) areas accounted for the highest proportion of infectious keratitis cases. P. aeruginosa and methicillin-sensitive S. aureus isolates were highly susceptible to fluoroquinolones, whereas 32% of coagulase-negative staphylococcus isolates tested were resistant to moxifloxacin and gatifloxacin, and all methicillin-resistant S. aureus organisms tested were resistant to these 2 fluoroquinolones. No organisms tested were resistant to tobramycin, gentamicin, or vancomycin. No fungal infections tested were resistant to voriconazole. CONCLUSIONS: Most infectious keratitis occurred in nonwinter months and in patients from suburban counties. Although fluoroquinolones were effective against the most common bacteria, staphylococcal species exhibited a high rate of resistance, representing a therapeutic challenge given the increasing use of fluoroquinolones as first-line monotherapy. No organisms tested were resistant to tobramycin, gentamicin, vancomycin, or voriconazole. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/25603231/Seasonal_geographic_and_antimicrobial_resistance_patterns_in_microbial_keratitis:_4_year_experience_in_eastern_Pennsylvania_ L2 - http://Insights.ovid.com/pubmed?pmid=25603231 DB - PRIME DP - Unbound Medicine ER -