Bakterielle Keratitis

Zusammenfassung

Entzündliche Hornhauterkrankungen sind weltweit betrachtet eine der führenden Ursachen monokularer Erblindung. Bakterielle Infektionen stehen dabei im Vordergrund und werden bei 80 % der Patienten mit ulzerativer Keratitis angetroffen. In den letzten Jahren sind sowohl veränderte Risikosituationen als auch Veränderungen im Keimspektrum zu beobachten. Kontaktlinsen und refraktivchirurgische Hornhauteingriffe sind Faktoren, die einigen Studien zufolge an Bedeutung zugenommen haben. Problemkeime wie Pseudomonas spp. und atypische Mykobakterien sind vor allem bei diesen Patienten nachweisbar. Demgegenüber wird die bakterielle Keratitis nach Trauma seltener beobachtet. Die breite, oft ungezielte Anwendung hochwirksamer antimikrobieller Wirkstoffe, vor allem von Fluorchinolonen, wird als ein Faktor für den Wandel des Keimspektrums angenommen. Aufgrund des oft problematischen Verlaufs der Keratitis und um eine gezielte, effektive Therapie einzuleiten, ist ein Erregernachweis erforderlich. Die Möglichkeiten der Diagnostik sind in den letzten Jahren durch molekularbiologische Techniken erweitert worden, ohne jedoch etablierte Verfahren ersetzen zu können. Ziel dieses Beitrags ist es, einen Überblick zu aktuellen Aspekten der bakteriellen Keratitis zu bieten.

Abstract

Worldwide inflammatory corneal diseases are considered to be one of the leading causes of monocular blindness. Bacterial infectious are still predominant and are found in 80 % of patients with ulcerative keratitis. In recent years, both changes in risk conditions and changes in the bacterial spectrum can be observed. Contact lenses and refractive surgery are factors that have increased in importance according to some studies. Microorganisms especially Pseudomonas spp. and atypical mycobacteria are detectable in these patients. In contrast, the bacterial keratitis is observed less frequently after trauma. The broad, often unsighted use of highly effective antimicrobial agents, especially of fluoroquinolones is assumed to be a factor in the transformation of the microbial spectrum. Due to the frequent course of keratitis and a targeted, effective therapy to initiate a pathogen is desirable. The possibilities of diagnostics have been expanded in recent years by molecular biological techniques, but cannot replace established methods. The aim of this paper is to provide a positioning on current aspects of bacterial keratitis.

Schlüsselwörter

bakterielle Keratitis - Diagnostik - Hornhautulkus - Therapie

Key words

bacterial keratitis - diagnostics - corneal ulcer - therapy

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