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

Anne Strong Caldwell1, Ari M Stoner1, Ellen Rhodes1

  • 1Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA.

Medicina (Kaunas, Lithuania)
|September 27, 2025
PubMed
Summary

Intensive care unit (ICU) admission for infectious keratitis (IK) in underserved patients may preserve vision but incurs high costs. Alternative strategies are needed to reduce ICU reliance while ensuring effective treatment for severe infectious keratitis.

Keywords:
corneal ulcerhealthcare costsinfectious keratitissocial determinants of health

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Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Health Services Research

Background:

  • Infectious keratitis (IK) management typically occurs outpatient, but severe cases or social barriers necessitate hospitalization.
  • Intensive care unit (ICU) admission for IK is often protocol-driven in safety-net hospitals for frequent topical antibiotic administration.
  • Underserved populations face unique challenges in managing IK, impacting treatment accessibility and outcomes.

Purpose of the Study:

  • To characterize ocular and social risk factors for ICU admission in patients with infectious keratitis.
  • To evaluate visual outcomes and financial costs associated with ICU admission for IK in an underserved population.
  • To identify reasons for ICU admission and explore alternative care strategies for infectious keratitis.

Main Methods:

  • Retrospective case series of patients admitted to the ICU for primary treatment of IK at Denver Health Medical Center (2017-2022).
  • Exclusion of patients admitted for other medical issues with concurrent IK.
  • Chart review for demographic data, ocular/social risk factors, microbiology, admission reasons, length of stay, hospital charges, and clinical outcomes.

Main Results:

  • 16 ICU admissions for IK in 14 patients (average age 51.7 years, 79% male).
  • High prevalence of social barriers: illicit drug use (71%), unhoused (36%). Common ocular risk factor: trauma (43%).
  • Mean length of stay 7.43 days, mean hospital charge $48,535.90. Most ulcers were large (88%) with poor initial vision (19% > HM). Primary reason for ICU admission: outpatient compliance concerns (63%). At follow-up, 40% had stable vision, 40% improved.

Conclusions:

  • ICU admission for infectious keratitis in socially vulnerable patients can preserve vision but incurs significant financial and societal costs.
  • Alternative care models and preventative interventions are crucial to decrease ICU resource utilization for IK.
  • Addressing social determinants of health is vital for optimizing infectious keratitis management in underserved populations.