Epidemiology and Outcomes of Kocuria Keratitis.

OBJECTIVE: To determine the characteristics of infectious keratitis caused by Kocuria spp. METHODS: Retrospective case series. Information included demographic data, medical history, risk factors associated with infectious keratitis, clinical characteristics, microbiological results and drug sensitivity, clinical course, management, and visual outcomes. RESULTS: Eight patients were included (7 females and 1 male; mean age, 66.2 years; age range, 42-84 years). All patients presented risk factors for infectious complications, such as filamentous keratitis, dry eye, blepharitis, and persistent corneal edema. In all cases, ulcers were classified as severe. The infection resolved with medical treatment in one eye only. One case was treated with amniotic membrane graft. Two patients required keratoplasty (lamellar and penetrating), and one case needed sclerokeratoplasty. In three cases, the keratitis was severe enough to require evisceration. The final visual acuity ranged from 20/25 to no light perception. CONCLUSIONS: Bacterial keratitis by Kocuria spp. is a rare infection that may have an unexpected clinical course and possible serious outcomes. This pathogen should be considered in patients with unusual clinical course. Local or systemic immune compromise in the genesis of the disease must also be taken into account, and ophthalmologists should be more suspicious in this vulnerable group of patients.

Trends in Microbiological and Antibiotic Sensitivity Patterns in Infectious Keratitis: 10-Year Experience in Mexico City.

PURPOSE: To report the distribution and trends in microbiological and antibiotic sensitivity patterns of infectious keratitis in a 10-year period at a reference center in Mexico City. METHODS: In this retrospective observational case series, samples were obtained from corneas with a diagnosis of infectious keratitis from January 2002 to December 2011 at the Institute of Ophthalmology "Conde de Valenciana" in Mexico City. Results of cultures, stains, and specific sensitivity/resistance antibiograms for each microorganism were analyzed. RESULTS: A total of 1638 consecutive corneal scrapings were analyzed. Pathogen was recovered in 616 samples (38%), with bacterial keratitis accounting for 544 of the positive cultures (88%). A nonsignificant increasing trend in gram-negative isolates (P = 0.11) was observed. The most commonly isolated pathogen was Staphylococcus epidermidis, and the most common gram-negative isolated species was Pseudomonas aeruginosa. Methicillin-resistant Staphylococcus aureus (MRSA) was present in 45% of the S. aureus isolates; meanwhile, 53.7% coagulase-negative Staphylococcus isolates were methicillin resistant (MRCNS). Pseudomonas aeruginosa resistance to ceftazidime increased from 15% in the first period to 74% for the last 5 years of the study (P = 0.01). The overall sensitivity for vancomycin of MRSA was 87.5%, whereas 99.6% of the MRCNS were sensitive. CONCLUSIONS: There was a nonsignificant increase in the recovered gram-positive and gram-negative microorganisms over time. We observed an increased resistance to methicillin in almost half of the MRSA and MRCNS isolates.

Clinical and microbiological profile of infectious keratitis in children.

BACKGROUND: Infectious keratitis is a sight-threatening condition for children. The purpose of this study was to describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children. METHODS: Retrospective review of clinical records of patients under 16 years of age with history of microbial keratitis seen at a tertiary referral center. Clinical characteristics, risk factors, visual and surgical outcomes as well as the microbiological profile are analyzed. RESULTS: Forty-one eyes of 41 patients. Mean age was 8.7 years. Time between the onset of symptoms and ophthalmological examination was 12.7 days. Predisposing factors were found in 78%; ocular trauma was the most common (25%). Visual acuity equal or worse than 20/200 at admission correlated positively with a poorer visual outcome, p=0.002. Positivity of cultures was 34%. Gram-positive bacteria were isolated in 78.5%; Staphylococcus epidermidis (28.6%) was the most common microorganism. CONCLUSIONS: Our study emphasizes the importance of a prompt diagnosis and treatment of infectious corneal ulcers in children. Trauma and contact lenses were the main predisposing factors. Gram-positive organisms were isolated in the vast majority of cases and visual outcomes are usually poor.