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Published on: May 12, 2020
Multidrug-Resistant Pseudomonas aeruginosa Keratitis: Risk Factors, Clinical Characteristics, and Outcomes
Jayesh Vazirani1, Siva Wurity1, Md Hasnat Ali2
1Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Visakhapatnam, India.
Purpose:
To identify risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) keratitis and to report clinical characteristics and outcomes of this infection.
Design:
Retrospective, case-control study.
Participants:
Ninety episodes of P. aeruginosa keratitis from a tertiary care eye institution from 2007 through 2014 were identified. Episodes of MDR-PA keratitis were taken as cases. Episodes of drug-sensitive P. aeruginosa keratitis during the same period were taken as controls.
Methods:
Chart review of cases and controls. Multidrug resistance was defined as resistance to 3 or more classes of antimicrobial drugs. Logistic regression analysis was used to determine association of baseline characteristics with multidrug resistance. Clinical characteristics and risk factors in each group also were compared.
Main Outcome Measures:
Risk factors for multidrug resistance, including age, gender, eye, duration of symptoms, topical steroid or lubricant ointment use, trauma, prior ocular surgery, presence of a compromised ocular surface, and bandage contact lens use.
Results:
Twenty-three episodes of MDR-PA keratitis (cases) and 67 episodes of drug-sensitive P. aeruginosa keratitis (controls) were identified. In the multivariate analysis, lubricant ointment use, presence of a compromised ocular surface, and bandage contact lens use were associated with MDR-PA keratitis. Antimicrobial resistance in the MDR-PA keratitis isolates was least for colistin and imipenem (56.52% each). Corneal perforation was more common in cases (52.17% [12 of 23]) than in controls (11.94% [8 of 67]; P = 0.0001). Cyanoacrylate glue application was required in 47.82% of cases (11 of 23), compared with 22.38% of controls (15 of 67; P = 0.031). Keratoplasty was more commonly required in cases (47.82% [11 of 23]) than in controls (20.89% [14 of 67]; P = 0.017).
Conclusions:
Lubricant ointment use, a compromised ocular surface, and bandage contact lens use are associated with MDR-PA keratitis. Preservative-free lubricant ointment may act as a source or reservoir of infection. Outcomes are worse in MDR-PA keratitis compared with drug-sensitive P. aeruginosa keratitis.
Insights
Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) keratitis risk factors include lubricant ointment use, compromised ocular surface, and bandage contact lens use. MDR-PA keratitis leads to worse outcomes compared to drug-sensitive infections.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Pseudomonas aeruginosa is a common cause of bacterial keratitis.
- Multidrug-resistant (MDR) strains pose a significant challenge due to limited treatment options.
- Identifying risk factors and understanding clinical characteristics of MDR-PA keratitis is crucial for effective management.
Purpose of the Study:
- To determine risk factors associated with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) keratitis.
- To describe the clinical features and outcomes of MDR-PA keratitis.
- To compare MDR-PA keratitis with drug-sensitive Pseudomonas aeruginosa keratitis.
Main Methods:
- Retrospective case-control study.
- Analysis of 90 episodes of P. aeruginosa keratitis (23 MDR-PA, 67 drug-sensitive).
- Logistic regression to identify risk factors, including ocular surface condition, contact lens use, and medication history.
Main Results:
- Lubricant ointment use, compromised ocular surface, and bandage contact lens use were significant risk factors for MDR-PA keratitis.
- MDR-PA keratitis cases showed higher rates of corneal perforation, required more cyanoacrylate glue application, and necessitated keratoplasty.
- Colistin and imipenem demonstrated the highest susceptibility rates against MDR-PA isolates.
Conclusions:
- Lubricant ointment, compromised ocular surface, and bandage contact lens use are key risk factors for MDR-PA keratitis.
- Preservative-free lubricant ointments may serve as a reservoir for infection.
- MDR-PA keratitis is associated with poorer clinical outcomes than drug-sensitive P. aeruginosa keratitis.
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