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A ten-year report of microbial keratitis in pediatric population under five years in a tertiary eye center
Mohammad Soleimani1, Seyed Ali Tabatabaei2, S Saeed Mohammadi2
1Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran. Soleimani_md@yahoo.com.
Insights
Trauma is the leading cause of microbial keratitis in children under five. Staphylococcus epidermidis was the most common pathogen, and fluoroquinolone monotherapy may be effective for small lesions.
Area of Science:
- Ophthalmology
- Microbiology
- Pediatrics
Background:
- Microbial keratitis is a serious eye infection that can lead to vision loss.
- Pediatric microbial keratitis is less common but can have significant consequences due to the challenges in diagnosis and treatment in young children.
Purpose of the Study:
- To characterize the clinical features, causative agents, and treatment outcomes of microbial keratitis in pediatric patients under five years of age.
- To identify the primary risk factors and common microorganisms involved in infectious keratitis in this age group.
Main Methods:
- A retrospective cross-sectional study included 93 pediatric patients (1-60 months) with infectious keratitis over ten years.
- Corneal scrapings were analyzed, and empiric antibiotic therapy was initiated, adjusted based on culture results.
- Tectonic procedures were performed for corneal thinning or perforation.
Main Results:
- The most frequent risk factor was trauma (40.9%), followed by contact lens use (8.6%).
- Staphylococcus epidermidis and Pseudomonas aeruginosa were the most common pathogens identified.
- Fluoroquinolone antibiotics demonstrated high sensitivity (93.8% for ciprofloxacin) against bacterial isolates.
Conclusions:
- Trauma is the primary cause of microbial keratitis in young children.
- Staphylococcus epidermidis is the most frequent pathogen.
- Fluoroquinolone monotherapy may be a suitable treatment option for small, non-central lesions without thinning in pediatric patients, considering antibiogram results and patient cooperation.
Purpose:
To report characteristics of microbial keratitis in pediatric patients under five years.
Methods:
Patients with infectious keratitis under the age of 5 years were included in this retrospective cross-sectional study for ten years. All patients were admitted and corneal scraping was performed in 81 children. Fortified empiric antibiotic eye drops including cefazolin (50 mg/cc) and amikacin (20 mg/cc) were started and the antibiotic regimen was continued or changed according to culture results. In the case of fungal keratitis, topical voriconazole (10 mg/cc) or natamycin (50 mg/cc) and topical chloramphenicol (5 mg/cc) were started. A tectonic procedure was done when corneal thinning or perforation was present.
Results:
Ninety-Three Patients between 1 to 60 months with a mean age of 33 ± 18 months old with corneal ulcer were included in the study. The most common risk factor was trauma (40.9%) followed by contact lens use (8.6%). Cultures were negative for microbial growth in 28 (30.1%) patients. The most common pathogens were S. epidermidis (10.8%) and P. aeruginosa (10.8%). Fluoroquinolone antibiotics (ciprofloxacin; 93.8% sensitivity) were the most potent antibiotic against bacterial pathogens. Forty-one patients underwent tectonic procedures, which the most common ones were cyanoacrylate glue 18.3% followed by keratoplasty 16.1%.
Conclusion:
This study emphasizes the role of trauma as the primary cause and S. epidermidis as the most frequent microorganism in pediatric keratitis; according to antibiogram results and poor cooperation of patients under five years, monotherapy with fluoroquinolones could be a good regimen in small non-central lesions without thinning.
