A Study of Clinico-Microbiological Profile and Treatment Outcomes of Infectious Keratitis

Background  Infectious keratitis (IK) is one of the major causes of corneal blindness in developing and developed nations. Numerous infections, including bacterial, fungal, viral, and protozoa, have been linked to IK. Corneal perforations can happen as one of the complications of IK. In this study, we aim to determine the clinical and microbiological profile and to study the treatment outcomes of IK. Material and methods It is a prospective, observational, and experimental study conducted in a tertiary care hospital and research center in Western Maharashtra, India, from September 2022 to June 2024. The sample size was 107 patients with IK. All patients were above 15 years of age, and all cases of microbial keratitis were within the inclusion criteria. Patients less than 15 years of age, patients with any other associated corneal pathology, healed cases of infectious keratitis, peripheral ulcerative keratitis, patients not willing to participate in the study, or not giving consent were excluded. Patients were examined thoroughly, and corneal scraping samples were collected and sent for microbiological examination. Appropriate treatment was provided through medical or surgical management, and treatment outcomes were evaluated during frequent follow-up visits. Results In our study, the majority of patients originated from rural areas, with most being over 60 years of age. Diabetes mellitus was seen in 24.3%, and a history of ocular trauma was present in 48.5% of patients. Staphylococcus epidermidis (3.74%) was the most common organism seen on gram staining, followed by Staphylococcus aureus (2.8%). Pseudomonas aeruginosa was the only gram-negative organism seen. The number of patients who had fungal isolates positive on culture was 57%, 12.1% had bacterial, and 30% had no growth of microorganisms. Fusarium species were seen in 39.2% of culture isolates, followed by Aspergillus flavus and Niger in 7.47% each. In 96% of medically managed patients, ulcers healed within two months. All ulcers with severe and moderate depth required therapeutic penetrating keratoplasty. A graft was in place in 95.2% after therapeutic penetrating keratoplasty, while one patient had graft rejection, and in one patient, endophthalmitis was seen. Conclusion Staphylococcus epidermidis was the most common bacterial agent isolated on gram staining, and Pseudomonas aeruginosa was the only gram-negative bacillus isolated on gram staining. Fungal isolates were the most common isolates observed on culture, seen in more than half of the IK patients in our study. The majority of patients who underwent medical management had ulcers healed in two months. The majority of the patients who underwent surgical management had fungal isolates positive. We recommend further research to be conducted in a generalized population, including urban settings, to understand the risk factors, microbiological profile, and treatment outcomes for IK.