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First Author: N.Lim SINGAPORE
Co Author(s): D. Lim M. Ray
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To compare risk factors, clinical characteristics, microbiological profile, and treatment outcomes of polymicrobial versus monomicrobial keratitis.
National University Hospital Singapore
In this retrospective comparative case series, eyes with polymicrobial and monomicrobial keratitis were identified from microbiological records from January 2002 to December 2010. Various parameters including demographics, risk factors, clinical and microbiological characteristics and treatment outcomes were analyzed.
Twenty-one eyes each with polymicrobial and monomicrobial keratitis were included. Contact lens usage was the commonest predisposing factor in both groups. Systemic (23.8%) and multiple (33.3%) risk factors were involved in polymicrobial group only. Mean age of patients, mean size of corneal infiltrates and mean duration for infection resolvement were significantly greater in the polymicrobial group. Medical treatment was successful only in 80.9% of eyes with polymicrobial keratitis, whereas all monomicrobial keratitis patients responded to it. A total of 44 organisms belonging to 18 species (bacteria=13, fungi=5) were isolated from the polymicrobial group, and Pseudomonas aeruginosa and candida albicans were the most frequently isolated bacteria (n=12) and fungi (n=5) respectively. In the polymicrobial group, gram-negative organisms were most sensitive to gentamicin (87.8%) and ciprofloxacin (78.7%), while gram-positive organisms were 100% sensitive to ciprofloxacin and cefazolin.
A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Contact lens usage was the most common risk factor in both groups. Corneal infiltrate size is a reliable indicator for suspecting polymicrobial keratitis. Prolonged course of disease and decreased antibiotic sensitivity were other notable features of polymicrobial keratitis.