Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Prognostic Factor and Antibiotic Susceptibility in Bacterial Keratitis: Results of an Eight-Year Period

세균각막염의 예후인자 및 항생제 감수성 변화에 대한 8년간의 고찰

Kim, Woo-Jin;Kweon, Eui-Yong;Lee, Dong-Wook;Ahn, Min;You, In-Cheon
김우진;권의용;이동욱;안민;유인천

  • Published : 2009.10.15
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Abstract

Purpose: To identify the clinical manifestations and risk factors for poor visual outcome, as well as antibiotic susceptibility of isolates in bacterial keratitis. Methods: A total of 128 eyes in 128 patients with bacterial keratitis, who were diagnosed by smears and cultures from January 2000 to December 2007 were reviewed retrospectively. Sex, age, previous ocular disease, trauma history, pre-treatment duration, previous ocular surgery, clinical manifestation, causative bacteria, pre- and post-treatment visual acuity, and treatment results were evaluated. An initial univariate and multivariate logistic regression analysis was performed to identify and select the main prognostic factors. The antibiotic susceptibility was evaluated in 2 consecutive 4-year periods. Results: The mean age of the 128 patients was 59.0${\pm}$18.2 years; 67 (52.3%) patients were male. The most common risk factor was ocular trauma (40.6%). The most prevalent isolate was coagulase-negative Staphylococcus (43.7%). Large size (p <0.001) and previous ocular disease (p <0.001) were significant prognostic factors in the multivariate logistic regression model. Resistance of cefazolin and aminoglycoside antibiotics that were commonly used as a combination therapy increased over the 8 years, but there was no significant difference in the 2 time periods tested (all p >0.05). Among the fluoroquinolone antibiotics, susceptibility of ciprofloxacin was 75.7%. Conclusions: In patients with bacterial keratitis, a large ulcer size and the presence of previous ocular disease were risk factors for poor visual outcome. Gentamicin, cefazolin, and ciprofloxacin should be avoided as primary monotherapy for bacterial keratitis.

목적: 세균각막염 환자의 임상양상과 시력 예후를 예측할 수 있는 인자와 함께, 원인균에 대한 항생제 감수성 결과를 알아보고자 하였다. 대상과 방법: 2000년 1월부터 2007년 12월까지 본원에서 각막염으로 진단받고 시행한 각막찰과 및 배양검사에서 세균이 검출된 128명 128안을 대상으로 의무기록을 후향적으로 조사하였다. 성별, 연령, 이전의 안질환, 외상 유무, 치료받기까지의 기간, 안과적 수술 기왕력, 초진 시 시력, 각막병변의 크기 및 깊이, 위치, 전방축농의 유무와 함께, 원인균, 치료 후 시력, 치료결과 등을 분석하였다. 이 중 치료실패와 관련 있는 위험인자를 로지스틱 회귀분석을 이용하여 조사하였다. 항생제 감수성 검사는 4년씩 전반기와 후반기로 나누어 조사하였다. 결과: 대상 환자 128명의 평균연령은 59.0${\pm}$18.2세였고, 남자가 67명(52.3%)이었다. 세균각막염 발생의 위험인자로는 외상(40.6%)이 가장 많았고, 가장 흔한 원인균은 Coagulase-negative Staphylococcus (43.7%)였다. 다변량 분석에서 시력저하의 위험인자로는 궤양의 크기가 큰 군(p <0.001)과 이전의 안질환이 있었던 경우(p <0.001)였다. 항생제 감수성 검사상 병합치료에 주로 사용되는 cefazolin과 aminoglycoside계 항생제의 내성이 증가되었으나, 8년간의 의미 있는 시간적 차이는 없었다. 퀴놀론 항생제 중 ciprofloxacin의 감수성은 75.7%로 낮은 감수성을 보였다. 결론: 각막궤양의 면적과 이전의 안질환 유무가 세균각막염의 치료 후 시력예후를 예측할 수 있는 위험인자였다. 세균각막염에서 일차 치료로서 gentamicin, cefazolin, ciprofloxacin의 단독 사용은 피해야 한다.

Keywords

References

  1. Erie JC, Nevitt MP, Hodge DO, Ballard DJ. Incidence of ulcerative keratitis in a defined population from 1950 through 1988. Arch Ophthalmol 1993;111:1665-71 https://doi.org/10.1001/archopht.1993.01090120087027
  2. Wilhelmus KR. Review of clinical experience with microbial keratitis associated with contact lens. CLAO J 1987;13:211-4
  3. Jones DB. Decision-making in the management of microbial keratitis. Ophthalmology 1981;88:814-20 https://doi.org/10.1016/S0161-6420(81)34943-4
  4. Blanton CL, Rapuano CJ, Cohen EJ, Laibson PR. Initial treatment of microbial keratitis. CLAO J 1996;22:136-40
  5. Afshari NA, Ma JJ, Duncan SM, et al. Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis. J Ocul Pharmacol Ther 2008;24:217-23 https://doi.org/10.1089/jop.2007.0085
  6. Snyder ME, Katz HR. Ciprofloxacin resistant bacterial keratitis. Am J Ophthalmol 1992;114:336-8
  7. Gelender H, Rettich C. Gentamicin-resistant Pseudomonas aeruginosa corneal ulcers. Cornea 1984;3:21-6
  8. Hahn YH, Hahn TW, Choi SH, et al. Epidemiology of infectious keratitis (I): a multicenter study. J Korean Ophthalmol Soc 1998;39:1633-51
  9. Hahn YH, Hahn TW, Tchah HW, et al. Epidemiology of infectious keratitis (II): a multicenter study. J Korean Ophthalmol Soc 2001;42:247-65
  10. Hahn YH, Lee SJ, Hahn TW, et al. Antibiotic susceptibilities of ocular isolates from patients with bacterial keratitis: a multicenter study. J Korean Ophthalmol Soc 1999;40:2401-10
  11. Mukerji N, Vajpayee RB, Sharma N. Technique of area measurement of epithelial defects. Cornea 2003;22:549-51 https://doi.org/10.1097/00003226-200308000-00012
  12. McLeod SD, Kolahdouz-Isfahani A, Rosamian K, et al. The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis. Ophthalmology 1996;103;23-8
  13. Ly CN, Pham JN, Badenoch PR, et al. Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluouroquinolones and gentamicin plus cephalothin. Clin Experiment Ophthalmol 2006;34:44-50 https://doi.org/10.1111/j.1442-9071.2006.01143.x
  14. Yeh DL, Stinnett SS, Afshari NA. Analysis of bacterial cultures in infectious keratitis, 1997 to 2004. Am J Ophthalmol 2006;142:1066-8 https://doi.org/10.1016/j.ajo.2006.06.056
  15. Bourcier T, Thomas F, Borderie V, et al. Bacterial keratitis:predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 2003;87:834-8 https://doi.org/10.1136/bjo.87.7.834
  16. Yilmaz S, Ozturk I, Maden A. Microbial keratitis in West Anatolia, Turkey: a retrospective review. Int Ophthalmol 2007;27:261-8 https://doi.org/10.1007/s10792-007-9069-2
  17. Wong T, Ormonde S, Gamble G, McGhee CN. Severe infective keratitis leading to hospital admission in New Zealand. Br J Ophthalmol 2003;87:1103-8 https://doi.org/10.1136/bjo.87.9.1103
  18. Katz NN, Wadud SA, Ayazuddin M. Corneal ulcer disease in Bangladesh. Ann Ophthalmol 1983;15:834-6
  19. Fong CF, Hu FR, Tseng CH, et al. Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan. Am J Ophthalmol 2007;144:682-9 https://doi.org/10.1016/j.ajo.2007.06.038
  20. Keay L, Edwards K, Naduvilath T, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006;113:109-16 https://doi.org/10.1016/j.ophtha.2005.08.013
  21. Green M, Apel A, Stapleton F. Risk factors and causative organisms in microbial keratitis. Cornea 2008;27:22-7 https://doi.org/10.1097/ICO.0b013e318156caf2
  22. Green M, Apel A, Stapleton F. A longitudinal study of trends in keratitis in Australia. Cornea 2008;27:33-9 https://doi.org/10.1097/ICO.0b013e318156cb1f
  23. Toshida H, Kogure N, Inoue N, Murakami A. Trends in microbial keratitis in Japan. Eye Contact Lens 2007;33:70-3 https://doi.org/10.1097/01.icl.0000237825.98225.ca
  24. Miedziak AI, Miller MR, Rapuano CJ, et al. Risk factors in microbial keratitis leading to penetrating keratoplasty. Ophthalmology 1999;106:1166-71 https://doi.org/10.1016/S0161-6420(99)90250-6
  25. Musch DC, Sugar A, Meyer RF. Demographic and predisposing factors in corneal ulceration. Arch Ophthalmol 1983;101:1545-8 https://doi.org/10.1001/archopht.1983.01040020547007
  26. McLeod SD, LaBree LD, Tayyanipour R, et al. The importance of initial management in the treatment of severe infectious corneal ulcers. Ophthalmology 1995;102:1943-8 https://doi.org/10.1016/S0161-6420(95)30771-3
  27. Morlet N, Minassian D, Butcher J, et al. Risk factors for treatment outcome of suspected microbial keratitis. Br J Ophthalmol 1999;83:1027-31 https://doi.org/10.1136/bjo.83.9.1027
  28. Bower KS, Kowalski RP, Gordon YJ. Fluoroquinolone in the treatment of bacterial keratitis. Am J Ophthalmol 1996;121:712-5
  29. Jhanji V, Sharma N, Satpathy G, et al. Fourth generation fluoroquinolone resistant bacterial keratitis. J Cataract Refract Surg 2007;33:1488-9 https://doi.org/10.1016/j.jcrs.2007.04.015
  30. Moshirfar M, Mirzaian G, Feiz V, Kang PC. Fourth generation fluoroquinolone resistant bacterial keratitis after refractive surgery. J Cataract Refract Surg 2006;23:515-8
  31. Alexandrakis G, Alfonso EC, Miller D. Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones. Ophthalmology 2000;107:1497-502 https://doi.org/10.1016/S0161-6420(00)00179-2
  32. Smitha S, Lalitha P, Prajna VN, Srinivasan M. Susceptibility trends of Pseudomonas species from corneal ulcers. Indian J Med Microbiol 2005;23:168-71 https://doi.org/10.4103/0255-0857.16588
  33. Pachigolla G, Blomquist P, Cavanagh HD. Microbiologic keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in North Texas. Eye Contact Lens 2007;33:45-9 https://doi.org/10.1097/01.icl.0000234002.88643.d0
  34. Kowal VO, Levey SB, Laibson PR, et al. Use of routine antibiotic sensitivity testing for the management of corneal ulcers. Arch Ophthalmol 1997;115:462-5 https://doi.org/10.1001/archopht.1997.01100150464002

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