Pediatric Microbial Keratitis: Identification of Clinical Biomarkers for Prognosis and Outcome of 218 Cases From 2009 to 2019
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Published on: May 12, 2020
Antonio Di Zazzo1, Mugundhan Rajan2, Rohit Dureja2
1Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy.
Purpose:
The aim of this study was to analyze the risk factors, microbiological profile, and treatment efficacy in pediatric microbial keratitis (MK) and to identify clinical biomarkers prognosticating outcome.
Methods:
A retrospective analysis was conducted from patients younger than 16 years with MK-excluding viral, marginal, or interstitial keratitis. Data pertaining to predisposing factors, symptom duration, prior treatment, ulcer characteristics, microbiological profile, time to resolution, and final outcome were recorded. Statistical analysis was performed. The mixed-effects linear regression model with random intercept was used to evaluate factors affecting time to resolution.
Results:
Among 218 episodes of 215 pediatric patients with MK, the geometric mean of central [median 3 mm, interquartile range (IQR) 1-4.3 mm] and peripheral ulcers (median 1 mm, IQR 1-2.5 mm) was significantly different ( P < 0.0001). Organisms identified were bacteria (56.9%), fungi (31.5%), and acanthamoebae (2.3%). Of 172 cases (78.8%), which resolved in a median resolution time of 22 days (IQR, 11-44 days), 107 (81.6%) with absent/negative microbiology healed on empirical therapy. On multivariate analysis, peripheral ulcers and geometric mean ulcer size affected time to resolution. Significantly higher percentage of eyes, which worsened or perforated, were on topical steroids compared with those which healed (31.8% vs. 9.2%, P = 0.0061).
Conclusions:
Good outcome even in culture negative cases suggests empirical therapy may be instituted for nonsevere peripheral pediatric MK; however, the importance of a microbiological workup cannot be underscored enough. Ulcer location and geometric mean size of ulcer may be used as clinical prognostic markers for resolution.
Insights
Pediatric microbial keratitis (MK) outcomes are influenced by ulcer location and size. Empirical therapy may be effective for non-severe peripheral MK, but microbiological workup remains crucial.
Area of Science:
- Ophthalmology
- Microbiology
- Pediatric Infectious Diseases
Background:
- Pediatric microbial keratitis (MK) is a significant cause of vision loss in children.
- Understanding risk factors and treatment efficacy is crucial for optimizing outcomes.
Purpose of the Study:
- To analyze risk factors, microbiological profile, and treatment efficacy in pediatric MK.
- To identify clinical biomarkers for predicting outcomes in pediatric MK.
Main Methods:
- Retrospective analysis of pediatric MK cases (<16 years).
- Data collected on predisposing factors, ulcer characteristics, microbiology, and treatment outcomes.
- Statistical analysis, including mixed-effects linear regression, was performed.
Main Results:
- Bacteria were the most common cause (56.9%), followed by fungi (31.5%).
- Peripheral ulcers and larger ulcer size were associated with longer resolution times.
- Topical steroid use correlated with worse outcomes (worsening or perforation).
Conclusions:
- Empirical therapy may be considered for non-severe peripheral pediatric MK, especially in culture-negative cases.
- Ulcer location and size are potential clinical prognostic markers for MK resolution.
- Microbiological workup remains essential for guiding treatment decisions.
