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An 18-Year Overview of Serratia marcescens Ocular Infection
Sarah Atta1, Chandrashan Perera, Shannon Nayyar
1Department of Ophthalmology (S.A., R.P.K., V.J.), University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Ophthalmology (C.P.), Stanford University School of Medicine, Stanford, CA; and The Charles T. Campbell Ophthalmic Microbiology Laboratory (S.N., R.P.K., V.J.), University of Pittsburgh Medical Center, Pittsburgh, PA.
Purpose:
Serratia marcescens is a frequent ocular bacterial pathogen implicated in keratitis, endophthalmitis, and conjunctivitis. We evaluated the risk factors and treatment outcomes of ocular infections due to S. marcescens.
Methods:
In this retrospective observational study, all S. marcescens-positive cases between February 2002 and February 2020 were reviewed for ocular risk factors that included log of minimal angle of resolution visual acuity (VA), medical management, and time to epithelial defect closure.
Results:
Fifty-one patients were identified (72.5% females, 46.8±23.3 years). Forty-six patients had complete medical records, and 5 had microbiology data available. The most prevalent ocular risk factors were, contact lens (CL) use (68.6%), corneal disease (52.9%), and history of ocular surgery (41.2%). Mean presenting VA was 1.3±1.0. About half of the patients presented with a central ulcer (49%, 25), large infiltrate (20.4±31.8 mm2 mean), and hypopyon (43.1%, 22). All cases were reported to be susceptible to ciprofloxacin. Defect closure occurred in 52.3±117.1 days and final VA was 0.86±0.88. Adjunctive treatments were required in 14 cases (27.5%). One patient underwent surgical intervention. Features associated with poor VA outcomes included, history of glaucoma (P=0.038), older age at presentation (P<0.001), presence of hypopyon (0.045), poor VA at presentation (0.0086), time to epithelial defect closure (0.0196), and large infiltrate size (P=0.0345).
Conclusions:
S. marcescens keratitis and conjunctivitis is associated with CL use and history of ocular surface disease. Worse outcomes were associated with older age, infiltrate size, presence of hypopyon, worse initial VA, longer time to epithelial defect closure, and history of glaucoma.
Insights
Serratia marcescens causes serious eye infections, often linked to contact lens use. Poor outcomes in keratitis and conjunctivitis are associated with older age, hypopyon, and delayed healing.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Serratia marcescens is a significant bacterial pathogen causing various ocular infections, including keratitis, endophthalmitis, and conjunctivitis.
- Understanding risk factors and treatment outcomes is crucial for managing these sight-threatening conditions.
Purpose of the Study:
- To evaluate the risk factors associated with ocular infections caused by Serratia marcescens.
- To assess the treatment outcomes for patients with Serratia marcescens ocular infections.
Main Methods:
- A retrospective observational study reviewed S. marcescens-positive ocular cases from February 2002 to February 2020.
- Data collected included ocular risk factors, visual acuity (VA), medical management, and time to epithelial defect closure.
Main Results:
- Fifty-one patients were identified, with contact lens use (68.6%), corneal disease (52.9%), and prior ocular surgery (41.2%) being prevalent risk factors.
- Common presentations included central ulcers, large infiltrates, and hypopyon. All isolates were susceptible to ciprofloxacin.
- Features associated with poor visual acuity outcomes included older age, presence of hypopyon, worse initial VA, longer epithelial defect closure time, and larger infiltrate size.
Conclusions:
- Serratia marcescens keratitis and conjunctivitis are frequently associated with contact lens use and a history of ocular surface disease.
- Worse visual outcomes are linked to older age, larger infiltrate size, hypopyon, poorer initial visual acuity, and delayed epithelial healing.
- Prompt management and identification of risk factors are essential for improving outcomes in S. marcescens ocular infections.
