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Contact lens-related bacterial keratitis: analysis of an outbreak and a 6 year follow-up report

Poster Details

First Author: S.Ofir ISRAEL

Co Author(s):    G. Litvin   H. El-Nadaf   Y. Paitan   A. Haia   F. Segev   E. Assia

Abstract Details



Purpose:

To study characteristics of an outbreak of bacterial keratitis in contact lens wearers and their possible cause as well as to evaluate the long term sequel

Setting:

Meir Medical Center, Kfar Saba, Israel

Methods:

Fifty three patients were identified within one year in a confined residential area at the coastal plain. Incidence rate increased from a multi annual average of 1.15 to 4.42 admittances per-month. All but one patient used soft contact lenses and over 80% of the lenses cleaning solutions were related to one manufacturer. Micro-organisms isolated were mainly gram negative, the most common being Pseudomonas Aeruginosa (P. Aeruginosa) found in 80% of positive corneal cultures. Resistance to Aminoglycoside antibiotics was unusually common (11%-15%) whereas resistance to Flouroquinolone antibiotics was low. The isolated organisms, mainly the pseudomonas species, were more resistant than control laboratory strains. The disinfecting solutions had a relatively low killing ability as compared to other solutions. Thirty eight patients (71.69%) completed a 6 year follow up. No recurrent bacterial keratitis was documented. Two patients underwent corneal transplant due to residual central corneal scars. Visual impairments led to occupational changes in 3 patients, 11 patients (29%) still use contact lenses, 4 wear glasses due to contact lens intolerance and 23 (60.52%) underwent refractive surgery. Nine patients (23%) still complain of residual visual impairments. Treatment with the classic aminoglycoside-cefalosporine combination was often insufficient and was changed to ofloxacin - fortified ceftazidime combination

Results:

Fifty three patients were identified within one year in a confined residential area at the coastal plain. Incidence rate increased from a multi annual average of 1.15 to 4.42 admittances per-month. All but one patient used soft contact lenses and over 80% of the lenses cleaning solutions were related to one manufacturer. Micro-organisms isolated were mainly gram negative, the most common being Pseudomonas Aeruginosa (P. Aeruginosa) found in 80% of positive corneal cultures. Resistance to Aminoglycoside antibiotics was unusually common (11%-15%) whereas resistance to Flouroquinolone antibiotics was low. The isolated organisms, mainly the pseudomonas species, were more resistant than control laboratory strains. The disinfecting solutions had a relatively low killing ability as compared to other solutions. Thirty eight patients (71.69%) completed a 6 year follow up. No recurrent bacterial keratitis was documented. Two patients underwent corneal transplant due to residual central corneal scars. Visual impairments led to occupational changes in 3 patients, 11 patients (29%) still use contact lenses, 4 wear glasses due to contact lens intolerance and 23 (60.52%) underwent refractive surgery. Nine patients (23%) still complain of residual visual impairments. Treatment with the classic aminoglycoside-cefalosporine combination was often insufficient and was changed to ofloxacin - fortified ceftazidime combination

Conclusions:

The combination of resistant pseudomonas strains and low efficacy of specific disinfecting solution led to an unusual high incidence bacterial keratitis – 53 cases within one year. Most cases responded well to proper antibiotic therapy. Laser refractive surgery was chosen as the practical means to treat ammetropia in 2/3 of the patients

Financial Disclosure:

NONE

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