Bacterial and Fungal Keratitis: A Retrospective Analysis at a University Hospital in Switzerland

Abstract

Background Infectious keratitis is a serious corneal disease and may lead to permanent visual deterioration if not treated rapidly and effectively. In order to determine possible changes in the spectrum of pathogens over time, we evaluated the pathogenic organisms of keratitis at a university hospital in Switzerland, comparing two time periods within a decade.

Methods In this retrospective study, 417 patients with the clinical diagnosis of bacterial or fungal keratitis in 2006/07 and 2015/16 were enrolled. In an additional analysis, all cases of fungal keratitis between 2006 and 2016 were evaluated. Collected parameters were age, gender, side, use of contact lenses, systemic, neurological and ocular diseases, trauma, previous surgery, and systemic and topical therapy before presentation. In each patient, microbiological results of corneal smears such as growth and antibiotic resistance were analysed.

Results A total of 163 and 254 eyes were included in 2006/07 and 2015/16, respectively. In 2006/07, a culture of smears revealed a bacterial cause in 70 eyes (42.9%) and a fungal cause in 4 eyes (2.5%), whereas in 2015/16, bacterial growth was found in 115 eyes (45.3%) and fungal growth in 6 eyes (2.4%). The most common bacteria in 2006/07 and 2015/16 were coagulase-negative Staphylococci (44.3 vs. 49.6%), Pseudomonas aeruginosa (18.6 vs. 13.9%), Staphylococcus aureus (10 vs. 16.5%), Corynebacterium spp. (8.6 vs. 5.2%), and Moraxella spp. (7.1 vs. 9.6%). Candida parapsilosis was the most common fungal isolate in both groups (25 vs. 33.3%). Between 2006 and 2016, fungal keratitis was found in 37 eyes (Candida spp. n = 11, Fusarium spp. n = 11, Aspergillus spp. n = 5, others n = 10). All patients with Fusarium spp. keratitis had a history of wearing contact lenses.

Conclusion The most commonly isolated bacterial organisms were Staphylococci and Pseudomonas spp., whereas fungal keratitis was mainly due to Candida spp. or Fusarium spp. No relevant variation in causative pathogens was observed between the two time periods.

Zusammenfassung

Hintergrund Eine infektiöse Keratitis ist eine schwere Hornhauterkrankung und kann, sofern nicht adäquat behandelt, zu einer permanenten Visusminderung führen. Um mögliche Änderungen im Keimspektrum über die Zeit festzustellen, haben wir eine Analyse der zugrunde liegenden Erreger an einer Universitätsklinik in der Schweiz durchgeführt, und hierfür 2 Zeitabschnitte innerhalb einer Dekade verglichen.

Patienten und Methoden In diese retrospektive Studie wurden 417 Patienten mit der klinischen Diagnose einer bakteriellen oder mykotischen Keratitis in den Jahren 2006/2007 und 2015/2016 eingeschlossen. In einer zusätzlichen Analyse wurden alle Pilzkeratitiden zwischen 2006 und 2016 evaluiert. Folgende Parameter wurden gesammelt: Alter, Geschlecht, betroffenes Auge, Tragen von Kontaktlinsen, systemische und neurologische Erkrankungen, andere Augenerkrankungen, Trauma, Voroperationen sowie systemische und topische Vortherapie.

Ergebnisse Für die Jahre 2006/2007 und 2015/2016 wurden jeweils 163 bzw. 254 Augen eingeschlossen. In den Jahren 2006/2007 konnte in den Kulturen eine bakterielle Ursache in 70 Augen (42,9%) und eine Pilzinfektion in 4 Augen (2,5%) nachgewiesen werden, während 2015/2016 Bakterien in 115 Augen (45,3%) und Pilze in 6 Augen (2,4%) als Ursache gefunden wurden. Die häufigsten bakteriellen Erreger 2006/2007 und 2015/2016 waren koagulasenegative Staphylokokken (44,3 vs. 49,6%), Pseudomonas aeruginosa (18,6 vs. 13,9%), Staphylococcus aureus (10 vs. 16,5%), Corynebacterium spp. (8,6 vs. 5,2%) und Moraxella spp. (7,1 vs. 9,6%). Candida parapsilosis war der am häufigsten isolierte Pilz (25 vs. 33,3%). Im Gesamtzeitraum 2006 – 2016 wurde in 37 Augen eine mykotische Keratitis nachgewiesen (Candida spp. n = 11, Fusarium spp. n = 11, Aspergillus spp. n = 5, andere = 10). Alle Patienten mit einer Fusarium-spp.-Keratitis waren Kontaktlinsenträger.

Schlussfolgerung Die am häufigsten isolierten bakteriellen Organismen waren Staphylokokken und Pseudomonaden, während Pilzkeratitiden hauptsächlich durch Candida spp. und Fusarium spp. bedingt waren. Es wurden keine relevanten Änderungen im Keimspektrum zwischen den 2 Zeitabschnitten gefunden.

Key words

bacterial keratitis - fungal keratitis - microbiology - coagulase-negative Staphylococcus - Pseudomonas aeruginosa

Schlüsselwörter

bakterielle Keratitis - Pilzkeratitis - Mikrobiologie - koagulasenegative Staphylokokken - Pseudomonas aeruginosa

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