Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal

Leena Bajracharya,1 Asta Ram Bade,2 Reeta Gurung,1 Kavita Dhakhwa1 1Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal; 2Department of Microbiology, Tilganga Institute of Ophthalmology, Kathmandu, NepalCorrespondence: Leena BajracharyaTilganga Institute of Ophthalmology, G.P...

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Autores principales:	Bajracharya L, Bade AR, Gurung R, Dhakhwa K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	microbial keratitis infective keratitis corneal ulcer Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/443712141fa94d26981a17666101ac8f
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spelling	oai:doaj.org-article:443712141fa94d26981a17666101ac8f2021-12-02T12:18:11ZDemography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal1177-5483https://doaj.org/article/443712141fa94d26981a17666101ac8f2020-10-01T00:00:00Zhttps://www.dovepress.com/demography-risk-factors-and-clinical-and-microbiological-features-of-m-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Leena Bajracharya,1 Asta Ram Bade,2 Reeta Gurung,1 Kavita Dhakhwa1 1Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal; 2Department of Microbiology, Tilganga Institute of Ophthalmology, Kathmandu, NepalCorrespondence: Leena BajracharyaTilganga Institute of Ophthalmology, G.P.O Box: 561 Gaushala, Kathmandu, NepalTel +977 1 4493775Fax +977- 1- 4474937Email lbajra@yahoo.comBackground: Infective keratitis is the most common corneal pathology in developing countries. Updated knowledge is needed for its control and proper management.Methodology: All cases of presumed microbial keratitis that presented in an 18-month period from October 2013 to March 2015 were enrolled. Data collected were demographic profile, risk factors, clinical features, and organisms isolated and their sensitivities.Results: A total of 602 cases of microbial keratitis were enrolled. Mean age of subjects (598 patients) was 47.9 years with 53.8% male. 64.1% worked in agriculture. 38.3% gave history of trauma followed by history of herpetic eye diseases (17.9%) and topical steroid use (14.2%). A total of 473 who were referred came at an average of 21.5 days of symptoms. 14.9% (n=90) of cases were either perforated or impending to perforate at presentation. 69.6% had infiltrate in the visual axis. A total of 516 (85.7%) underwent diagnostic corneal culture. A total of 256 (49.6%) yielded a positive result. Pure bacterial growth was seen in 111 (43.4%), pure fungal growth in 138 (53.9%), and mixed microbial growth was present in 7 (2.7%) cases. Out of 121 bacterial isolates, 95.0% were Gram positive. Streptococcus pneumoniae (45.5%, n=55) was the most common bacterial isolate followed by Staphylococcus aureus (20.6%, n=25). Out of 145 fungal isolates, Aspergillus and Fusarium species were found in equal numbers (n=41, 28.3% each). Over 85% of Gram-positive organisms isolated in the study were sensitive to vancomycin, cefazolin, moxifloxacin, and gatifloxacin. Over 80% of Gram-negative organisms were sensitive to gentamicin, tobramycin, and amikacin.Conclusion: Microbial keratitis and associated risk factors occurring in farmers implies a lack of awareness and prevention programs. Delay in reaching tertiary care is resulting in complicated cases. Training of local health workers for prophylaxis, updated guidelines for treating keratitis, and timely referral to higher centers are all important in a chain to decrease the incidence of microbial keratitis.Key words: microbial keratitis, infective keratitis, corneal ulcerBajracharya LBade ARGurung RDhakhwa KDove Medical Pressarticlemicrobial keratitisinfective keratitiscorneal ulcerOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 3219-3226 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	microbial keratitis infective keratitis corneal ulcer Ophthalmology RE1-994
spellingShingle	microbial keratitis infective keratitis corneal ulcer Ophthalmology RE1-994 Bajracharya L Bade AR Gurung R Dhakhwa K Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
description	Leena Bajracharya,1 Asta Ram Bade,2 Reeta Gurung,1 Kavita Dhakhwa1 1Department of Cornea, Tilganga Institute of Ophthalmology, Kathmandu, Nepal; 2Department of Microbiology, Tilganga Institute of Ophthalmology, Kathmandu, NepalCorrespondence: Leena BajracharyaTilganga Institute of Ophthalmology, G.P.O Box: 561 Gaushala, Kathmandu, NepalTel +977 1 4493775Fax +977- 1- 4474937Email lbajra@yahoo.comBackground: Infective keratitis is the most common corneal pathology in developing countries. Updated knowledge is needed for its control and proper management.Methodology: All cases of presumed microbial keratitis that presented in an 18-month period from October 2013 to March 2015 were enrolled. Data collected were demographic profile, risk factors, clinical features, and organisms isolated and their sensitivities.Results: A total of 602 cases of microbial keratitis were enrolled. Mean age of subjects (598 patients) was 47.9 years with 53.8% male. 64.1% worked in agriculture. 38.3% gave history of trauma followed by history of herpetic eye diseases (17.9%) and topical steroid use (14.2%). A total of 473 who were referred came at an average of 21.5 days of symptoms. 14.9% (n=90) of cases were either perforated or impending to perforate at presentation. 69.6% had infiltrate in the visual axis. A total of 516 (85.7%) underwent diagnostic corneal culture. A total of 256 (49.6%) yielded a positive result. Pure bacterial growth was seen in 111 (43.4%), pure fungal growth in 138 (53.9%), and mixed microbial growth was present in 7 (2.7%) cases. Out of 121 bacterial isolates, 95.0% were Gram positive. Streptococcus pneumoniae (45.5%, n=55) was the most common bacterial isolate followed by Staphylococcus aureus (20.6%, n=25). Out of 145 fungal isolates, Aspergillus and Fusarium species were found in equal numbers (n=41, 28.3% each). Over 85% of Gram-positive organisms isolated in the study were sensitive to vancomycin, cefazolin, moxifloxacin, and gatifloxacin. Over 80% of Gram-negative organisms were sensitive to gentamicin, tobramycin, and amikacin.Conclusion: Microbial keratitis and associated risk factors occurring in farmers implies a lack of awareness and prevention programs. Delay in reaching tertiary care is resulting in complicated cases. Training of local health workers for prophylaxis, updated guidelines for treating keratitis, and timely referral to higher centers are all important in a chain to decrease the incidence of microbial keratitis.Key words: microbial keratitis, infective keratitis, corneal ulcer
format	article
author	Bajracharya L Bade AR Gurung R Dhakhwa K
author_facet	Bajracharya L Bade AR Gurung R Dhakhwa K
author_sort	Bajracharya L
title	Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
title_short	Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
title_full	Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
title_fullStr	Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
title_full_unstemmed	Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal
title_sort	demography, risk factors, and clinical and microbiological features of microbial keratitis at a tertiary eye hospital in nepal
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/443712141fa94d26981a17666101ac8f
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Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal

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