Epidemiology and Outcome of Microbial Keratitis: Private University Versus Urban Public Hospital Care
Epidemiology and Outcome of Microbial Keratitis: Private University Versus Urban Public Hospital Care
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DOI：
10.1097/icl.0000000000000334
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发表时间：
2018-09-01
影响因子：
2.3
通讯作者：
Cavanagh, H. Dwight
中科院分区：
文献类型：
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作者：
Truong, David T.;Minh-Thuy Bui;Cavanagh, H. Dwight
用途：回顾流行病学，危险因素，微生物学谱，并在5年期间在城市公立医院与相邻的私立大学practice.Methods相比，治疗微生物性角膜炎：回顾性图表审查在5年的时间间隔，2009年至2014年。主要结果的措施包括患者的年龄在介绍，最佳矫正视力（BCVA），危险因素，文化和敏感性，治疗，并发症occurrence.Results：共有528眼与微生物角膜炎被确定，318在公共队列和210在私人队列。隐形透镜配戴是公共队列中最常见的风险因素，而眼表疾病是私人队列中最常见的风险因素。革兰氏阳性菌占47.3%，革兰氏阴性菌占32.1%，真菌占13.6%，阿米巴占6.4%。庆大霉素耐药率为4.4%，妥布霉素耐药率为2.9%。公共队列的住院治疗率为40%，而私人队列为4%。在公共队列中，消退时的平均BCVA为20/82（最小消退角的对数[logMAR] 0.61）。对于私人队列，消退时的平均BCVA为20/73 [logMAR，0.56]。穿孔率在公立队列中为8%，而在私立队列中为4%。6%的情况下进行了紧急穿透性角膜移植术在公共队列与2%在私人coherent.Conclusions：微生物角膜炎仍然是一个临床挑战，在城市公立医院设置。在公立医院就诊的患者的风险状况可能与在私人护理机构就诊的患者不同。公立医院的病人可能在感染过程中出现较晚，因此无论是否进行有效的抗菌治疗，并发症的发生率都较高。
Purpose: To review the epidemiology, risk factors, microbiologic spectrum, and treatment of microbial keratitis during a 5-year period at an urban public hospital in comparison with an adjacent private university practice.Methods: Retrospective chart review in the 5-year interval, 2009 through 2014. Primary outcome measures included patient age at presentation, best-corrected visual acuity (BCVA), risk factors, culture and sensitivities, treatment, and complication occurrence.Results: A total of 528 eyes with microbial keratitis were identified, 318 in the public cohort and 210 in the private cohort. Contact lens wear was the most common risk factor in the public cohort, whereas ocular surface disease was the most common risk factor in the private cohort. Gram-positive organisms represented 47.3%, gram-negative organisms 32.1%, fungal organisms 13.6%, and Acanthamoeba 6.4% of corneal isolates. Gentamicin resistance was 4.4% and tobramycin resistance was 2.9%. The inpatient treatment rate of the public cohort was 40% compared with 4% in the private cohort. In the public cohort, average BCVA at resolution was 20/82 (log of minimal angle of resolution [logMAR] 0.61). For the private cohort, average BCVA at resolution was 20/73 [logMAR, 0.56]. The perforation rate was 8% in the public cohort compared with 4% in the private cohort. Six percent of cases underwent urgent penetrating keratoplasty in the public cohort versus 2% in the private cohort.Conclusions: Microbial keratitis remains a clinical challenge in the urban public hospital setting. The risk profile of patients presenting in the public hospital setting may be different from patients presenting in a private care setting. Public hospital patients may present later in the course of their infection and thus have a higher rate of complications regardless of effective antimicrobial therapy.