Elsevier

American Journal of Ophthalmology

Volume 205, September 2019, Pages 74-81
American Journal of Ophthalmology

Original Article
Microbial Keratitis in Taiwan: A 20-Year Update

https://doi.org/10.1016/j.ajo.2019.03.023Get rights and content

Purpose

To investigate the demographics, risk factors, microbiology, and resistance pattern at a tertiary hospital and to detect the shifting trend over 2 decades.

Design

A retrospective observational case series.

Methods

We reviewed all records of patients with microbial keratitis (MK) that were hospitalized in National Taiwan University Hospital between 2007 and 2016. Demographics, predisposing factors, pathogens, and clinical courses were compared to our previous study conducted from 1992 to 2001. Antibiotic susceptibility was compared with those conducted from 1994 to 2005.

Results

The percentage of patients 60 years and older in the MK population was increasing (P = 2.1E-21). The proportion of trauma-related MK declined while MK related to chronic ocular or systemic disorders rose. The prevalence of nontuberculous mycobacteria (NTM) showed a decreasing trend (P = .0032), whereas Microsporidia has been increasingly detected. The 2 most common bacterial isolates were Pseudomonas aeruginosa (35.2%) and Staphylococcus species (13.2%). Management of these infection did not differ in common pathogens between the 2 decades. The susceptibility of Staphylococcus species to oxacillin reduced significantly (P = .002) and there was an increase in methicillin-resistant Staphylococcus aureus keratitis.

Conclusions

Contact lens wear remained the most common predisposing factor, with Pseudomonas species as the major pathogen. However, chronic disorder–related MK was on the rise along with an increasing trend of oxacillin resistance in Staphylococcus species. We found a decreasing trend in NTM keratitis while Microsporidia keratitis was considered as an emerging ocular disease. Though gram-negative isolates remained susceptible to all antibiotics tested, antibiotic resistance was more common in gram-positive isolates.

Section snippets

Methods

The study conformed to the provisions of the Declaration of Helsinki and was approved by the Institutional Research Ethics Board of National Taiwan University Hospital (IRB number: 201610028RINB). We reviewed the medical records of hospitalized patients with clinically diagnosed microbial keratitis between 2007 and 2016. The following noninfectious corneal diseases were excluded: superficial injury of cornea, open wound of eyeball, corneal opacity, and cases of viral keratitis. Patient

Demographics

The demographic data are summarized in Table 1. From 2007 to 2016, a total of 370 eyes from 363 patients were identified. Seven cases had a simultaneous bilateral infection. Patients included 171 men (47.1%) and 192 women (52.9%), aged from 4 to 93 years (mean age 50.2 ± 23.3 years). The average age of the microbial keratitis population became older (40.7 ± 21.6 years in 1992-2001 vs 50.2 ± 23.3 in 2007-2016; P =3.5E-9). The age distribution in comparison with previous data from 1992 to 1996

Discussion

This study updated the microbiology data and patient demographics of microbial keratitis in Taiwan to establish reference information for clinicians. There was a slight female preponderance in our cases and the commonest risk factor documented was contact lens use, consistent with other domestic data.3, 4 This may be owing to a greater proportion of contact lens–associated keratitis composed of female patients, as previous studies suggested.5, 6 However, the absolute number of contact

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    • Epidemiology and the Estimated Burden of Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based Study

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      Citation Excerpt :

      However, the incidence of microbial keratitis in the present study cannot be compared with those revealed in previous studies because of differences in the populations, study designs, and study durations. Previous single-center studies conducted in Taiwan reported that contact lens wear was the leading risk factor for microbial keratitis during the preceding 2 decades,11,17,21 which could be explained by the high prevalence of myopia and the popularity of contact lens use by young people in Taiwan. The statistical data of the Ministry of Economic Affairs demonstrated the increasing domestic sales volume of soft contact lenses during the study period (Supplementary Figure D; Supplemental Material available at AJO.com).22

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    Supplemental Material available at AJO.com.

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