Clinico-Microbiological Profile Of Klebsiella Keratitis At A Tertiary Care Centre

Infectious keratitis is one of the most common causes of corneal blindness in the developing world. Gram negative corneal infections are associated with poor outcomes due to higher virulence and increased prevalence of multidrug resistance. Klebisella is known to be one such organism affecting the cornea and sclera. Our study aims to characterize the clinico-microbiological profile and outcomes of Klebsiella keratitis.

A multi- tier hospital network in South Asia.

Retrospective medical records-based study. All cases of culture proven Klebsiella keratitis were included during the study period from January 2010 - December 2022. Records were collected both from the Electronic Medical Records ( EMR ) and paper records across the network. A total of 62 cases were included in the study.Mean presenting age was 45.6 +/- 17.9 years. Eight patients (12.9%) had one or more systemic comorbidities. An ocular inciting factor was identified in 38 (61.3%) cases. Mean visual acuity at presentation was 1.88+/- 0.65 logMAR.Median size of the infiltrate was 3mm and scleral involvement was seen in two (3.2%) patients. 

An accurate diagnosis based solely on clinical features was made in 30 (48.4%) cases. Corneal scrapings were obtained for 56 (90.3%) and showed gram negative bacilli in 33 (53.6%) cases. Median duration to resolution was 29 days. Steroids were added in 21(33.4%) cases after a median duration of 10 days after starting topical antibiotic therapy. Therapeutic keratoplasty was required in 5(8.1%) cases and three patients underwent evisceration. Final visual acuity was 2.01 +/- 1.2 logMAR. Worse final visual acuity or need for was associated with size (r=0.34; p=0.04), depth of the infiltrate (p<0.001) and presence of an ocular inciting factor (p=0.023). Addition of steroid was not associated with a better outcome(p=0.09)

Age, initial logMAR visual acuity and inciting agent were found to be statistically significant predictor of final outcome i.e. final logMAR visual acuity according to simple linear regression.According to multiple linear regression, with each unit increase in initial logMAR visual acuity, there was 0.596 times increase in final logMAR visual acuity (adjusted β: 0.596; 95% CI: 0.109 to 1.084). Klebsiella keratitis has a poor visual outcome despite effective treatment and is commonly seen in immunocompromised eyes and those with a poor ocular surface and history of previous surgery. A significant number of eyes have a worse visual acuity than at presentation. Addition of topical steroids does not lead to significantly favourable outcomes.