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Microbial Keratitis in Taiwan: A 20-Year Update.

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Microbial keratitis (MK) is increasingly affecting older adults and those with chronic disorders. While Pseudomonas aeruginosa remains common, Staphylococcus aureus shows rising antibiotic resistance, highlighting emerging challenges in ocular infection management.

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Microbial keratitis (MK) is a significant cause of ocular morbidity.
  • Understanding trends in MK demographics, risk factors, and causative pathogens is crucial for effective management.
  • Antimicrobial resistance patterns require continuous monitoring to guide treatment strategies.

Purpose of the Study:

  • To investigate the changing demographics, risk factors, microbiology, and antibiotic resistance patterns of microbial keratitis over two decades.
  • To identify emerging trends and shifts in the epidemiology of MK at a tertiary hospital.

Main Methods:

  • A retrospective observational case series design was employed.
  • Patient records from 2007–2016 were reviewed and compared with data from 1992–2001 (demographics, risk factors) and 1994–2005 (antibiotic susceptibility).
  • Analysis included demographics, predisposing factors, pathogens, clinical courses, and antibiotic susceptibility.

Main Results:

  • The proportion of MK patients aged 60 years and older increased significantly.
  • Trauma-related MK decreased, while MK associated with chronic ocular or systemic disorders rose.
  • Nontuberculous mycobacteria (NTM) prevalence decreased, whereas Microsporidia detection increased. Pseudomonas aeruginosa and Staphylococcus species were the most common bacterial isolates.
  • Oxacillin resistance in Staphylococcus species significantly increased, with a rise in methicillin-resistant Staphylococcus aureus (MRSA) keratitis.

Conclusions:

  • Microbial keratitis is increasingly affecting older individuals and those with chronic health conditions.
  • While Pseudomonas aeruginosa remains a primary pathogen, rising oxacillin resistance in Staphylococcus species, including MRSA, poses a growing concern.
  • Microsporidia keratitis is emerging, necessitating vigilance, while NTM keratitis is declining.