1054例化脓性角膜炎的回顾性分析

目的探讨化脓性角膜炎的病原学和临床特征。方法对1999年1月至2004年12月间于山东省眼科研究所、青岛眼科医院诊治的1054例化脓性角膜炎住院患者的人口学特征、症状持续时间、疾病危险因素、就诊前接受的治疗及实验室检查结果等资料进行回顾性分析。结果化脓性角膜炎中真菌性角膜炎所占比例最高（61．9％）,41～50岁的中年患者（27．3％）和农民（82．9％）最多见。角膜损伤是最常见的发病危险因素。氢氧化钾湿片直接镜检法诊断真菌性角膜炎的阳性率为88．7％,而革兰染色镜检法检查细菌性角膜炎的阳性率仅为43．4％。分离到的真菌中镰刀菌属占73．3％,其次为曲霉菌属（12．1％）。分离到的细菌病原谱中,以铜绿假单胞菌居多（35．7％）,其次为表皮葡萄球菌（22．5％）。结论真菌性角膜炎在严重的化脓性角膜炎中最常见且呈现逐年递增的趋势。氢氧化钾湿片直接镜检法是一种快速、简便及有效的真菌性角膜炎诊断工具。     

Suppurative corneal ulceration in Bangladesh

Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary, Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.     

Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India

PURPOSE: To determine the epidemiological pattern and risk factors involved in suppurative corneal ulceration in Gangetic West Bengal, eastern India, and to identify the specific microbial agents responsible for corneal infections. METHODS: All patients with suspected microbial keratitis presenting to the corneal clinic at Disha Eye Hospital, Barrackpore, West Bengal, India, from January 2001 to December 2003 were evaluated. Sociodemographic data and information pertaining to the risk factors were recorded. After diagnosing infective corneal ulcer clinically, corneal scraping and cultures were performed. RESULTS: Over a three-year period, 1198 patients with suppurative keratitis were evaluated. Ocular trauma was the most common predisposing factor in 994 (82.9%) patients (P< 0.0001), followed by use of topical corticosteroids in 231 (19.28%) patients. Cultures were positive in 811 (67.7%) patients. Among these culture positive cases, 509 (62.7%) patients had pure fungal infections (P< 0.001), 184 (22.7%) patients had pure bacterial infections and 114 (14.1%) had mixed fungal with bacterial infections. Acanthamoeba was detected in 4 (0.49%) patients. The most common fungal pathogen was Aspergillus spp representing 373 (59.8%) of all positive fungal cultures (P< 0.0001), followed by Fusarium spp in 132 (21.2%) instances. Most common bacterial isolate was Staphylococcus aureus, representing 127 (42.6%) of all the bacterial culture (P< 0.0001) followed by Pseudomonas spp 63 (21.1%). CONCLUSION: Suppurative keratitis in Gangetic West Bengal, most often occurs after a superficial corneal trauma with vegetative or organic materials. Fungal ulcers are more common than bacterial ulcers. Aspergillus spp and Staphylococcus aureus were the most common fungus and bacteria respectively. These "regional" findings have important public health implications for the treatment and prevention of suppurative corneal ulceration in this region of India.     

细菌性角膜炎病原学分析

目的：回顾分析细菌性角膜炎致病菌属的分布及变化。方法：对1989－1999年间送检的2220份细菌性角膜炎细菌培养标本进行革兰染色及分类,对不同菌属的分布及变化情况进行回顾性分析。结果：在2220份培养的角膜细菌标本中,培养阳性菌株490 株,阳性率为22．1％。其中革兰阳性球菌250株,占51．0％;革兰阴性球菌2株,占0．4％;革兰阴性杆菌193株,占39．4％;革兰阳性杆菌45株,占9．2％。假单胞菌属的检出率最高,占32．2％,其次为凝固酶阴性葡萄球菌属为18．6％,第3位肺炎球菌12．0％。10年中,革兰阳性球菌检出率呈上升趋势,革兰阴性杆菌检出率则呈下降趋势。结论：假单胞菌属及凝固酶阴性葡萄球菌属仍是细菌角膜炎较常见的致病菌,革兰阴性杆菌检出率下降与革兰阳性球菌检出率升高趋势应引起临床眼科医师的注意。     

Epidemiological, clinical and laboratory findings of infectious keratitis at Mansoura Ophthalmic Center, Egypt

AIM: To analyze the epidemiological, clinical and laboratory findings of infectious keratitis. METHODS: A retrospective study on cases of infective keratitis, attended our institution from Mar. 2013 to Feb. 2015, was done at Mansoura Ophthalmic Center, Egypt. Corneal scrapings were performed and processed for direct microscopy and culture in appropriate media using standard laboratory protocols. RESULTS: Out of 245 patients enrolled for study, 247 corneal scrapings were obtained. Ocular trauma was the most common predisposing factor (51.4%), followed by diabetes mellitus (15.1%). Cultures were positive in 110 scraping samples (44.5%): 45.5% samples had pure fungal infection, 40% had pure bacterial infections and 10% had mixed fungal and bacterial growths. Acanthamoeba was detected in 5 (4.5%) samples. The most common fungal pathogen was Aspergillus spp. (41%). The most common bacterial isolates were Staphylococcus aureus (38.2%) and Pseudomonas aeruginosa (21.8%). CONCLUSION: Incidence of fungal keratitis is high in our region. Therapeutic approach can initially be based on clinical features and sensitivity/resistance patterns. Microbiological research should direct the antimicrobial treatment. Antibiotic resistance to fluoroquinolones and aminoglycosides is an important consideration.     

Distribution and shifting trends of bacterial keratitis in north China (1989-98)

AIMS: To study the distribution and shifting trends of bacterial keratitis. METHODS: The data of 2220 corneal isolates from 1 January 1989 to 31 December 1998 were reviewed retrospectively. RESULTS: Positive culture was recovered in 490 isolates. Gram positive cocci and Gram negative bacilli represented 51% and 39.4%, respectively. Pseudomonas aeruginosa was the most common pathogen (32.2%). A gradual increase in the percentage of Gram positive cocci coupled with a decrease of Gram negative bacilli. CONCLUSION: Pseudomonas aeruginosa and coaculase negative Staphylococcus were the most common pathogens in bacterial keratitis in north China.     

Infectious keratitis in South Australia: emerging resistance to cephazolin

PURPOSE: To analyze the microbiologic spectrum and patterns of resistance of infectious keratitis in patients treated at a tertiary hospital in South Australia. METHODS: Retrospective review of microbiology laboratory records of all patients with infectious keratitis who had corneal scrapings, from 1998 to 2003. All records were subsequently reviewed for Gram staining and culture results, as well as antibiotic sensitivity and resistance. RESULTS: Positive corneal cultures were obtained in 134 out of 211 patients who had corneal scrapings (63.5%). Coagulase negative Staphylococcus was the commonest pathogen identified (29.8% of positive cultures), followed by Staphylococcus aureus (18.7%), Pseudomonas aeruginosa (12.7%), Moraxella (6.7%), Streptococcus pneumonia (6.0%), and fungal keratitis (5.2%). In 43.3% of culture positive cases, the organisms were also identified in Gram stain, and in all these cases there was a full correlation between the two methods. In vitro sensitivities were highest for gentamicin. Fourteen cases (35%) of coagulase negative Staphylococcus were found to be resistant to cephazolin. No ciprofloxacin resistance was identified in all Pseudomonas isolates tested. CONCLUSIONS: Staphylococcus species continue to be the commonest causative organism for infectious keratitis; however, there is an emerging resistance to cephazolin, which is commonly used as the first-line antibiotic for Gram-positive cocci.     

Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India

AIMS/BACKGROUND—To determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in Madurai, south India, and to identify the specific pathogenic organisms responsible for infection.
METHODS—All patients with suspected infectious central corneal ulceration presenting to the ocular microbiology and cornea service at Aravind Eye Hospital, Madurai, from 1 January to 31 March 1994 were evaluated. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined, and corneal cultures and scrapings were performed.
RESULTS—In the 3 month period 434 patients with central corneal ulceration were evaluated. A history of previous corneal injury was present in 284 patients (65.4%). Cornea cultures were positive in 297 patients (68.4%). Of those individuals with positive cultures 140 (47.1%) had pure bacterial infections, 139 (46.8%) had pure fungal infections, 15 (5.1%) had mixed bacteria and fungi, and three (1.0%) grew pure cultures of Acanthamoeba. The most common bacterial pathogen isolated was Streptococcus pneumoniae, representing 44.3% of all positive bacterial cultures, followed by Pseudomonas spp (14.4%). The most common fungal pathogen isolated was Fusarium spp, representing 47.1% of all positive fungal cultures, followed by Aspergillus spp (16.1%).
CONCLUSIONS—Central corneal ulceration is a common problem in south India and most often occurs after a superficial corneal injury with organic material. Bacterial and fungal infections occur in equal numbers with Streptococcus pneumoniae accounting for the majority of bacterial ulcers and Fusarium spp responsible for most of the fungal infections. These findings have important public health implications for the treatment and prevention of corneal ulceration in the developing world.

     

儿童感染性眼病的病原学及其耐药性分析

目的 探讨14岁以下儿童非病毒性感染性眼病的病原体类型、分布及其耐药性.方法 实验研究.回顾性分析1999至2004年期间首都医科大学附属北京同仁医院、北京同仁眼科中心临床诊断为感染性眼病儿童的眼部标本785份,对其进行细菌、真菌及阿米巴的培养与鉴定,分析培养阳性病原体的种类、分布以及细菌和真菌体外药物敏感性.结果 采用X2检验进行统计学分析.结果 在785份送检标本中,微生物培养阳性211份,培养阳性率为26.88%,其中细菌培养阳性176份,占83.41%;真菌培养阳性32份,占15.17%;阿米巴培养阳性3份,占1.42%.176份细菌培养阳性标本中,单株细菌感染138份;多重细菌感染33份;细菌与真菌混合感染5份.共培养鉴定出细菌214株.其中淋球菌属39株,占18.22%;表皮葡萄球菌属37株,占17.29%;棒状杆菌属36株,占16.82%.培养鉴定的32株真菌中,镰刀菌属8株,占25.00%;曲霉菌属5株,占15.63%.眼部细菌对妥布霉素、诺氟沙星、庆大霉素、阿米卡星、环丙沙星、氧氟沙星、利福平及左氧氟沙星的敏感百分比分别为62.57%、64.94%、70.06%、70.87%、71.19%、73.89%、85.80%及87.50%.左氧氟沙星和利福平的敏感性百分比均分别高于妥布霉素、诺氟沙星、庆大霉素、阿米卡星、环丙沙星及氧氟沙星(左氧氟沙星X2=15.654、13.536、8.767、7.908、7.286、5.538,利福平X2=13.923、11.921、7.459、6.666、6.095、4.500;均P<0.05).革兰阳性菌对左氧氟沙星敏感;革兰阴性菌对氧氟沙星、环丙沙星及左氧氟沙星敏感.眼部感染真菌对那他霉素敏感性最高,其次为特比萘酚,对氟康唑敏感性较差.结论 细菌是儿童非病毒性感染件眼病最主要的病原体;其中淋病奈瑟菌、表皮葡萄球菌、棒状杆菌属常见,对左氧氟沙星与利福平敏感性较高.儿童眼部致病真菌中,镰刀菌与曲霉菌属常见,对那他霉素敏感性最高,对氟康唑敏感性较差.(中华眼科杂志,2009,45:141-145)     

Effektivität antibiotischer Initialtherapie in der Behandlung der kontaktlinsenassoziierten bakteriellen Keratitis

Background

Contact lens-related microbial keratitis is a cause of potentially sight-threatening corneal opacification. Effective initial antimicrobial therapy is crucial to prevent long-term complications. This investigation was undertaken to test the effectiveness of current routine empirical antibiotic treatment regimens.

Methods/patients

All consecutive cases of contact lens-related keratitis presenting in the outpatient clinic of the Department of Ophthalmology at the Medical University of Innsbruck between January 2010 and April 2012 were retrospectively analyzed.

Results

Cultures were positive in 69 out of the 123 cases included in the study. Culture results identified 59.4?% Gram positive strains, 50.7?% Gram negative strains and 7.2?% fungal strains. Mixed infections accounted for 29?% of cases. The combination of an aminoglycoside and a second generation quinolone antibiotic was the most common initial treatment regimen (87.8?%). In vitro this regimen was less effective compared to combinations of moxifloxacin and ciprofloxacin or moxifloxacin and gentamicin.

Conclusion

Empirical combined regimens remain an effective treatment of contact lens-related keratitis. Fluoroquinolones proved to be inadequate for monotherapy.     

Bacteriological profile of ophthalmic infections in an Israeli hospital.

AIM: To find the optimal antibiotic treatment for ophthalmic infections in an Israeli hospital. METHODS: In a retrospective study from our laboratory, which serves as both a primary and secondary referral center, we analyzed the bacteriological profile and the antibiotic sensitivity of ophthalmic infections using the computerized laboratory reports of 331 consecutive ophthlamic bacteriological cultures from patients with various ophthalmic infections. RESULTS: Microbiological growth was obtained in 113 samples (34.1%). The most commonly isolated organism was coagulase-negative staphylococcus (19.5%), followed by coagulase-positive staphylococcus (16.8%), Enterobacteriaceae (14.2%), Pseudomonas aeruginosa (13.3%), and streptococcal species (8.9%). Pseudomonas species were the most common isolates from the lacrimal pathways (20.0%). Streptococci were the most common isolates cultured from the conjunctiva (27.3%). Coagulase-positive staphylococcus was the most common isolate from corneal ulcers (33.3%), and coagulase-negative staphylococcus from the vitreous (30.8%). The overall antibiotic sensitivity of common ophthalmic pathogens was similar to that reported from other parts of the world. CONCLUSIONS: Although essentially similar to previous series, this report from the Middle East differs as follows. Firstly, Pseudomonas species were the most common isolates from the lacrimal pathways. Secondly, the overall rate of streptococcal isolates was lower than in previous reports. Thirdly, streptococcal species were rarely isolated from corneal samples. Although other studies from the region have described the causative organisms of ocular infections in specific ocular sites, this is the first study from the Middle East to summarize the full bacteriological profile of ocular infections in one medical center.     

Infectious keratitis in Baltimore.

One hundred thirty cases of ulcerative keratitis occurring from 1985 to 1989 at Sinai Hospital of Baltimore were reviewed. Positive corneal cultures were obtained from 40% of cases. The most common isolates were Staphylococcus epidermidis (28%), S. aureus (16%), and Pseudomonas aeruginosa. P. aeruginosa was the most common in contact lens wearers. Antibiotic pretreatment did not affect the rate of positive cultures significantly. Bilateral conjunctival and eyelid margin cultures also were examined. An association was found between corneal and ipsilateral conjunctival isolates (P = .05). Gram stains were consistently negative. Most patients were treated successfully as outpatients. The value of simultaneous conjunctival and eyelid margin cultures and Gram stains was questioned.     

马来西亚东西部感染性角膜炎研究

目的：评估马来西亚东西部三级医院感染性角膜炎流行病学及发病因素。

方法：收集来自马来西亚西部Sungai Buloh医院、吉隆坡综合医院和东部Queen Elizabeth医院、沙捞越州综合医院的感染性角膜炎患者207例。研究记录了危险因素。进行角膜刮片镜检和培养。

结果：马来西亚西部感染性角膜炎最普遍的风险因素是植物性损伤(28.5%)和非植物性损伤(18.3%)。27.7%的创伤病例与工作有关,其中外籍男性工作者占34.2%。马来西亚东部最普遍的风险因素是配戴隐形眼镜(32.9%)。马来西亚东西部绿脓假单胞菌是感染性角膜炎最常见的病菌。马来西亚西部最常见的真菌病原体是镰刀菌,占所有阳性真菌培养物的60%。

结论：马来西亚东西部公立医院细菌性角膜炎检出率较高,而东部隐形眼镜配戴则是常见风险因素(P<0.05),西部真菌性角膜炎检出率高。     

Predisposing factors and etiologic diagnosis of ulcerative keratitis

PURPOSE: To determine the predisposing factors, demographic characteristics, and etiology of ulcerative keratitis in a referral center in Bangkok, Thailand. METHODS: The medical records of admitted patients with positive-culture ulcerative keratitis were retrospectively reviewed for demographic data, predisposing factors, and microbial culture results. Predisposing factors were compared between bacterial and fungal keratitis. RESULTS: From January 2001 to December 2004, there were 127 positive-culture ulcerative keratitis cases. The most frequent microbiological diagnosis was bacterial keratitis (76 eyes, 60%), followed by fungal (48 eyes, 38%) and Acanthamoeba keratitis (3 eyes, 2%). The most common organisms isolated were Pseudomonas spp. for bacteria and Fusarium spp. for fungus. Compared with bacterial keratitis, fungal keratitis was more likely to be associated with ocular trauma (odds ratio = 11.20; 95% confidence interval, 3.62-34.66) but less likely to be associated with contact lens wear (odds ratio = 0.02; 95% confidence interval, 0.01-0.08). CONCLUSIONS: In our study, Pseudomonas and Fusarium species are the most common causes of bacterial and fungal keratitis, respectively. Fungal keratitis was more likely than bacterial keratitis to be associated with ocular trauma, whereas fungal keratitis was less likely to be associated with contact lens wear.     

华南地区某眼科医院的感染性角膜炎病原菌谱特征

目的 探讨华南地区某眼科医院感染性角膜炎的病原菌谱及其特点。方法 回顾性系列病例研究。选择2013年7月1日至2017年12月31日在中山大学中山眼科中心进行角膜取材和微生物检测的角膜感染患者3 914例。表面麻醉后刮取病灶边缘的病灶组织,进行细菌、真菌培养及鉴定。培养结果阳性的细菌采用生化比色或质谱进行种属鉴定;真菌依据形态学进行种属鉴定。各季节菌谱阳性率差异比较采用卡方检验。结果 感染性角膜炎患者中,男2 468例（63.1%）,女1 446例（36.9%）,年龄（49.5±16.8）岁。病原菌培养阳性的患者共1 673例（42.7%）,其中单纯细菌749例（44.8%）,单纯真菌849例（50.7%）,混合感染75例（4.5%）。最常见的细菌是葡萄球菌属（20.1%）,其次是假单胞菌属（7.5%）;最常见的真菌是镰刀菌属（25.5%）,其次是曲霉菌属（10.3%）。细菌的阳性率在5-8月明显高于1-2月和9-12月（P<0.05）,真菌的阳性率在5-6月明显低于1-2月和9-12月（P<0.05）。结论 在华南地区一所三甲眼科医院的感染性角膜炎中,真菌感染略高于细菌感染,且细菌和真菌感染存在季节性差异。     

Systematic review of 342 cases of endogenous bacterial endophthalmitis

We review a total of 342 cases of endogenous bacterial endophthalmitis reported between 1986 and 2012. Predisposing conditions were present in 60%, most commonly diabetes, intravenous drug use, and malignancy. The most common sources of infection were liver, lung, endocardium, urinary tract, and meninges. Systemic features such as fever were present in 74%, hypopyon in 35%, and an absent fundal view in 40%. Diagnostic delay occurred in 26%. Blood cultures were positive in 56%, and at least one intraocular sample was positive in 58% (comprising 26% anterior chamber samples, 59% vitreous taps, and 41% vitrectomy specimens). Worldwide, Gram negative infections (55%) were more frequent than Gram positive (45%) infections, particularly in Asia. Over the last decade, 11% of eyes were treated with systemic antibiotics alone, 10% intravitreal antibiotics alone, 36% systemic plus intravitreal antibiotics, and 20% systemic plus intravitreal antibiotics plus pars plana vitrectomy. The most commonly used intravitreal antibiotics were vancomycin (for Gram positive infection) and ceftazidime (Gram negative). The median final visual acuity was 20/100, with 44% worse than 20/200. Among all cases, 24% required evisceration or enucleation, and mortality was 4%. Both intravitreal dexamethasone and vitrectomy were each associated with a significantly greater chance of retaining 20/200 or better and significantly fewer eviscerations or enucleations—these warrant further study. For most patients, treatment should include a thorough systemic evaluation and prompt intravitreal and systemic antibiotics.     

准分子激光原位角膜磨镶术前结膜囊细菌分析

目的观察准分子激光原位角膜磨镶术(1aser in situ keratomileusis，LASIK)术前患者结膜囊细菌分布及药物敏感性。方法对LASIK术前100例患者(200只眼)结膜囊取材进行细菌培养，并观察培养阳性的细菌对10种常见抗生索的体外药物敏感性。结果在200只眼结膜囊标本中细菌培养阳性者58眼(71株)，阳性率29%，共分离鉴定出12个细菌种属；其中革兰氏阳性菌为85．9％，革兰氏阴性菌为14．1％；金黄色葡萄球菌、表皮葡萄球菌、棒状杆菌属及假单胞菌属为LASIK术前患者结膜囊存在的常见菌属。药敏结果发现所分离细菌对阿米卡星和左氧氟沙星最敏感。结论革兰氏阳性菌是LASIK术前患者结膜囊存在的最常见菌，术前预防性抗生素使用应注意选择对革兰氏阳性菌敏感的抗生素。     

Epidemiological and microbiological profile of infective keratitis in Ahmedabad

Context:

Study of patients attending tertiary care ophthalmology institute at Ahmedabad.

Aims:

To study the microbiological etiology and epidemiological factors associated with suppurative keratitis.

Settings and Design:

A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008.

Materials and Methods:

Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded.

Results:

Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31).

Conclusion:

Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.     

Reliability of transport medium in the laboratory evaluation of corneal ulcers

PURPOSE: To compare the microbiological yield of corneal ulcer cultures established by direct inoculation of culture media vs indirect inoculation by means of transport medium (Amies without charcoal). DESIGN: Single masked, prospective clinical trial. METHODS: Scrapings were obtained for Gram and potassium hydroxide (KOH) stains from eyes with presumed infectious keratitis and cultured by direct plating onto standard media. Samples were also held in transport media (Amies without charcoal) at room temperature and then plated after 4 and 24 hours. Yields from direct plating vs cultures by means of transport media were compared. RESULTS: Of 100 consecutive eyes examined with presumed infectious keratitis, Gram or KOH stain revealed a bacterial or fungal agent in 69 cases (69%). Of these, 26 were bacterial and 43 fungal. Twenty-two bacterial infections produced positive cultures by direct plating, and all produced the same organism with Amies medium after 4 and 24 hours, respectively. For 43 fungal infections identified by KOH stain, 29 (67%) yielded a positive result after 4 hours in Amies transport medium and 27 (63%) after 24 hours in Amies medium. A total of three cases (7%) that showed fungal infection on KOH stain but did not yield organisms by direct plating did so after inoculation with Amies transport medium. For all comparisons, there was no difference in recovery rates by means of transport medium compared with direct plating (McNemar exact P > .05). CONCLUSIONS: In the clinical setting, Amies transport medium may be a useful alternative to direct inoculation onto blood agar for the laboratory evaluation of infectious keratitis.     

Microbial keratitis in Waikato, New Zealand

Background: Bacterial keratitis is a potentially sight‐threatening condition. This study is performed to identify the common causative organisms for bacterial keratitis in Waikato region and the antibiotic sensitivities to these organisms. Design: Retrospective, observational, case series. Participants: The microbiology records of all patients with bacterial keratitis who presented to the Ophthalmology department, Waikato Hospital, New Zealand between January 2003 and December 2007. Methods: The corneal scrape results were reviewed. Antibiotic sensitivity for the organism was tested following National Committee for Clinical Laboratory Standards (NCCLS) method. Main Outcome Measures: In vitro laboratory susceptibility testing of ocular isolates to various antibiotics. Results: A total of 265 scrapes were performed. Gram stain was positive in 35 (13.2%) eyes. Positive culture was seen in 174 (65.6%) scrapes; 78.2% were Gram‐positive and 20.2% were Gram‐negative organisms. Most common Gram‐positive organisms were coagulase‐negative Staphylococci (40.8%) and Staphylococcus aureus (11.5%). Most common Gram‐negative organisms were Moraxalla species (8.0%) and Pseudomonas aeroginosa (3.4%). Of the bacterial organisms 99% were sensitive to ciprofloxacin. All Gram‐negative organisms and 95.5% Gram‐positive organisms were sensitive to tobramycin; 96.6% Gram‐positive organisms and 98.3% Gram‐negative organisms were sensitive to cefuroxime. Conclusions: Our results are comparable to other regions in New Zealand but the incidence of coagulase‐negative Staphylococcus is much higher in this region compared with other New Zealand studies. It seems appropriate to start patients with corneal ulcers initially on fluoroquinolone monotherapy while awaiting culture results.