Paediatric infectious keratitis: a case series of 107 children presenting to a tertiary referral centre

Br J Ophthalmol. 2017 Nov;101(11):1488-1492. doi: 10.1136/bjophthalmol-2016-310119. Epub 2017 Mar 15.

Abstract

Background/aims: Corneal ulcers can result in severe visual impairment in children. The recent trends of paediatric microbial ulcerative keratitis in the USA are unknown. The purpose of this study is to report the risk factors, microbiological profile and treatment outcomes of paediatric microbial keratitis in South Florida.

Methods: A university-based tertiary eye care centre retrospective case series between 1992 and 2015. Medical records of 107 paediatric patients (age <18 years) with the diagnosis of microbial ulcerative keratitis were analysed. Patient demographics, culture data, microbial susceptibility, management trends and patient outcomes were collected.

Results: Mean age of patients was 13±4.6 years (range 0.2-17 years). The most common associated risk factor was contact lens wear (77.6%), followed by ocular trauma (8.4%). Systemic factors were present in 4.7% of cases. Cultures were taken from 89 patients. A total of 74 organisms were isolated from the 52 corneal scrapings with growth, yielding a 58.4% positivity rate. Seventeen microbial species were identified, with a predominance of Pseudomonas aeruginosa (46.2%), followed by Stenotrophomonas maltophilia (19.2%) and Fusarium (13.5%). Combined fortified antibiotics were the most common treatment (51.4%). Mean follow-up time was 40.6±91.6 weeks (range: 0.3-480 weeks). The mean visual acuity improved from 20/160 to 20/50 (p<0.0001). No therapeutic penetrating keratoplasty was needed.

Conclusions: In this study, contact lens wear was the most frequent risk factor in infectious keratitis in children. P. aeruginosa was the most common microorganism present in our setting. The majority of the cases responded well to medical management.

Keywords: Child health (paediatrics); Contact lens; Cornea; Infection; Microbiology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / isolation & purification*
  • Child
  • Child, Preschool
  • Cornea / microbiology*
  • Disease Management*
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Female
  • Florida / epidemiology
  • Humans
  • Infant
  • Keratitis / drug therapy
  • Keratitis / epidemiology*
  • Keratitis / microbiology
  • Male
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Risk Assessment*
  • Risk Factors
  • Tertiary Care Centers / statistics & numerical data*

Substances

  • Anti-Bacterial Agents