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Microbial keratitis in Sydney, Australia: risk factors, patient outcomes, and seasonal variation

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Abstract

Purpose

To provide recent data on patient demographics, clinical profile and outcomes of patients with microbial keratitis over a 5-year period at the Sydney Eye Hospital, and to identify seasonal variations of the main causative organisms.

Method

A retrospective study of patients with a clinical diagnosis of microbial keratitis and corneal scrape performed between 1 January 2012 and 31 December 2016. Clinical information was gathered from medical records and pathology data.

Results

One thousand fifty-two eyes from 979 patients with a mean age of 54.7 ± 21.5 years (range 18–100 years) were included. The majority of cases were bacterial (65%) followed by polymicrobial (2.4%), fungi (2.3%), and culture-negative (31%). Common risk factors for microbial keratitis were contact lens wear (63%) and previous topical steroid use (24%). Factors significantly associated with poor patient outcomes in the multivariate model were age, visual acuity, and epithelial defect size (p < 0.05). Patients with fungal or polymicrobial keratitis presented with worse clinical features at initial and final presentation (p < 0.05). There was a significant variation in the occurrence of Pseudomonas aeruginosa (p = 0.018) and fungal keratitis (predominately made up of Candida and Fusarium species) (p = 0.056) in the hottest seasons.

Conclusion

Poorer outcomes are more likely to be seen in older patients and those presenting with poor visual acuity and large epithelial defects at the initial presentation.

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Acknowledgments

The authors acknowledge the corneal unit at the Sydney Eye Hospital who managed the patients with microbial keratitis in this case series.

Funding

Pauline Khoo is supported by an Australian Government Training Program Scholarship and the Ophthalmology and Vision Science PhD Scholarship from the University of Sydney, Australia.

Stephanie Watson is supported by the Sydney Medical School Foundation.

The Sydney Eye Hospital Foundation supported the study.

Author information

Authors and Affiliations

  1. The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, South Block, Level 1, 8 Macquarie St, Sydney, NSW, 2000, Australia

    Pauline Khoo, Maria P. Cabrera-Aguas, Vuong Nguyen & Stephanie L. Watson

  2. Microbiology Department, New South Wales Health Pathology, The Prince of Wales Hospital, Randwick, NSW, Australia

    Monica M. Lahra

  3. School of Medical Sciences, The University of New South Wales, Sydney, Australia

    Monica M. Lahra

  4. Department of Ophthalmology, Sydney Eye Hospital, Sydney, NSW, Australia

    Stephanie L. Watson

Authors
  1. Pauline Khoo
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  2. Maria P. Cabrera-Aguas
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  3. Vuong Nguyen
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  4. Monica M. Lahra
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  5. Stephanie L. Watson
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Corresponding author

Correspondence to Pauline Khoo.

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The authors declare that they have no conflict of interest.

Informed consent

Participant consent was not required due to the retrospective nature of the study. This was approved via our ethics committee (i.e., South Eastern Sydney Local Health District, Australia).

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Khoo, P., Cabrera-Aguas, M., Nguyen, V. et al. Microbial keratitis in Sydney, Australia: risk factors, patient outcomes, and seasonal variation. Graefes Arch Clin Exp Ophthalmol 258, 1745–1755 (2020). https://doi.org/10.1007/s00417-020-04681-0

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