Changing Trend In The First Contact Management Profile Of Infective Keratitis

To re-evaluate the management pattern followed in the first contact management of infectious keratitis and to compare it with our previous study. To evaluate the change in generation of causative agents and their antibiotic sensitivity and resistance patterns.

An institutional study conducted at a tertiary care centre in India. (Dr. R.P.Centre for ophthalmic sciences, AIIMS New Delhi, India)

A retrospective analysis of the demographic, clinical, and microbiological data was performed in 100 consecutive patients with infectious keratitis. The main parameters evaluated were the nature of first contact with the health care services, investigations undertaken, treatment initiated, and the time interval between presentation to the first medical contact and to our centre. Finally, the reports of culture and antibiotic sensitivity testing undertaken at our centre were evaluated. These results were compared with the similar study, which was conducted in our centre 25 years ago.

In 70% of cases, ophthalmologists in independent practice were the first medical contact. 46% of the patients were prescribed 4th-generation fluoroquinolone eyedrops in an inadequate dosage. Positive cultures were obtained in 73.86% of cases, and the common organisms are Staphylococcus (33.84%), followed by Pseudomonas aeruginosa (15.38%). A large number of the isolates demonstrated resistance to the recommended antibiotic therapy. On comparing with the previous study, certain patterns remained unchanged: delayed presentation, low rates of microbiological testing, and empirical broad-spectrum antibiotic use. There is an increase in antimicrobial resistance, particularly among Gram-positive organisms, reflecting evolving microbial ecology.

Our study underscores the persistent challenges in the management of infective keratitis, including delayed presentations, inadequate early diagnostics, and rising antimicrobial resistance. Addressing these issues requires a multifaceted approach encompassing public health education, capacity building at the primary care level, and the integration of novel diagnostic technologies. By fostering a more proactive and informed approach to keratitis management, we can improve patient outcomes and mitigate the burden of corneal blindness.