Clinical Characteristics, Outcomes, and Cost Associated with Inpatient Intensive Care for Infectious Keratitis

Background and Objectives: Infectious keratitis (IK) is typically managed in an outpatient setting, but patients with severe infections or significant social barriers may require hospital admission. In safety-net hospital systems, these admissions to the intensive care unit (ICU) occur due to hospital protocols for frequent topical antibiotic administration. This study aims to characterize the ocular and social risk factors, visual outcomes, and financial costs associated with ICU admission for IK in an underserved population. Materials and Methods: We conducted a retrospective case series of all patients admitted to the ICU for primary treatment of IK at the Denver Health Medical Center between 1 January 2017 and 31 December 2022. Patients admitted for other medical issues with concurrent IK were excluded. Demographic data, ocular and social risk factors, microbiological culture results, reasons for admission, length of stay, hospital charges, and clinical outcomes were obtained via chart review. Results: Fourteen patients with 16 ICU admissions were included. The average age was 51.7 years, and 79% were male. Most patients endorsed current illicit drug use (71%), and 36% were unhoused. The most common ocular risk factor was trauma (43%). Mean length of stay was 7.43 days, with a mean hospital charge of $48,535.90 per admission. Most ulcers were large (88%) and presented with poor vision (only 19% had better than hand motion vision). The most common reason for ICU admission was concern about outpatient compliance (63%). At last follow-up, 40% of patients had stable vision and 40% had improved vision compared to admission. Conclusions: ICU admission for IK in patients with significant social barriers may preserve vision, but it comes with substantial financial and societal cost. Alternative care strategies and preventative interventions should be considered to reduce reliance on ICU resources while maintaining effective treatment.