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Microbial keratitis following vegetative matter injury
Mukesh Taneja1, Jatin N Ashar, Anurag Mathur
1Cornea and Anterior Segment Services, L.V. Prasad Eye Institute, Hyderabad, India.
Abstract:
The purpose of the present study was to analyze the microbiological profile of cases of keratitis following trauma with vegetative matter in a tertiary care center. A retrospective review of the medical records of 49 patients with keratitis following vegetative matter injury over a 3-month period was performed. All patients underwent corneal scraping for smears and inoculation onto various culture media. The microbiological profile was based on the smear and culture reports. For patients who were culture-negative, outcome after standard empirical antibacterial therapy as per hospital protocol was analyzed. Thirteen patients with corneal ulcers had fungal etiology, eight had bacterial etiology, and two had protozoal etiology, while 13 patients were polymicrobial and 13 were culture-negative. Polymicrobial infections were mainly bacterial (eight cases), and the remaining five cases had coexistent fungal and bacterial etiology. The treatment was directed to the specific organism and patients improved with medical or surgical therapy. Only a third of culture-negative cases showed fungal etiology on biopsy or histopathology after keratoplasty while a third showed improvement with therapy. Corneal infections following vegetative matter trauma show a varied etiological profile; however, bacterial and polymicrobial infections are more prevalent. Empirical anti-fungal therapy, as commonly practiced, must be avoided in cases with vegetative matter injury.
Insights
Vegetative matter eye injuries often cause varied infections, with bacterial and polymicrobial keratitis being most common. Avoid empirical antifungal treatment for these injuries, as it may not be effective.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- Corneal infections following trauma, especially with vegetative matter, present a significant clinical challenge.
- Understanding the microbiological profile is crucial for effective treatment and preventing vision loss.
Purpose of the Study:
- To analyze the microbiological profile of keratitis cases resulting from vegetative matter trauma.
- To guide appropriate empirical therapy in such cases.
Main Methods:
- Retrospective review of 49 patients with keratitis after vegetative matter injury.
- Corneal scraping for smears and cultures to identify causative organisms.
- Analysis of culture-negative cases and outcomes with empirical antibacterial therapy.
Main Results:
- Diverse etiologies were observed: 13 fungal, 8 bacterial, 2 protozoal, 13 polymicrobial, and 13 culture-negative.
- Polymicrobial infections were predominantly bacterial, with some coexisting fungal and bacterial cases.
- Culture-negative cases showed varied outcomes, with some improving with therapy and others identified as fungal on biopsy post-keratoplasty.
Conclusions:
- Corneal infections from vegetative matter trauma have a varied microbiological spectrum, with bacterial and polymicrobial infections being prevalent.
- Empirical antifungal therapy is not recommended for vegetative matter-induced keratitis due to the diverse etiology.
- Tailoring treatment based on microbiological findings or clinical suspicion is essential for favorable outcomes.
