Clinical And Microbiological Outcomes Of Infectious Keratitis In Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis

To evaluate the impact of type 2 diabetes mellitus (T2DM) on infectious keratitis severity, positive microbial culture rates, and microbial distribution patterns.

A retrospective study conducted at Carmel Medical Center, a tertiary medical center. The study included patients diagnosed with infectious keratitis between 2013-2020.

We conducted a retrospective analysis of 853 patients diagnosed with infectious keratitis at Lady Davis Carmel Medical Center between 2013 and 2020. Severe cases were defined as those requiring tectonic keratoplasty. Microbial cultures were performed in 296 patients, with 98 yielding positive results. Associations between T2DM, positive culture rates, and severe outcomes were assessed using logistic regression and chi-square tests.

Patients with T2DM demonstrated a significantly higher risk of severe keratitis (OR = 2.50, 95% CI: 1.18 - 5.29, p = 0.016). Neither age (OR = 1.004, 95% CI: 0.99 – 1.01 ,p= 0.07) nor gender (OR = 0.97, 95% CI: 0.48 – 1.94, p = 0.925) were found to be significant risk factors for severe prognosis. T2DM patients were more likely to have positive cultures (OR = 2.52, 95% CI: 1.23 - 5.17, p = 0.012). A non-significant trend toward a higher prevalence of Gram-positive infections was observed in T2DM patients but was not statistically significant (p = 0.152). The most frequently isolated pathogen among non-diabetic patients was Pseudomonas aeruginosa (30.4%), while in diabetic patients it was Streptococcus pneumoniae (33.3%).

T2DM is associated with increased severity of infectious keratitis and higher positive culture rates. Although a trend toward more Gram-positive infections in diabetic patients was noted, it was not statistically significant. The findings emphasize the importance of careful management and close monitoring of infectious keratitis in patients with T2DM.