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Bacterial keratitis in the critically ill

B Parkin1, A Turner, E Moore

  • 1Bristol Eye Hospital.

The British Journal of Ophthalmology
|March 14, 1998
PubMed
Summary
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Implementing preventative eye care measures significantly reduced bacterial keratitis cases in intensive care unit patients. This highlights the importance of eye care protocols for ventilated patients to prevent serious ocular complications.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Intensive Care Medicine

Background:

  • Nine cases of bacterial keratitis, primarily Pseudomonas aeruginosa, occurred in critically ill patients (1988-1991) on an intensive care unit, leading to severe visual deficits.
  • The problem of keratitis in ventilated patients was not isolated to one unit, with additional cases reported in other area units.
  • Ocular infections were preceded by respiratory tract colonization with Pseudomonas aeruginosa, indicating a potential transmission route.

Purpose of the Study:

  • To investigate predisposing factors for bacterial keratitis in critically ill, ventilated patients.
  • To evaluate the impact of implemented preventative eye care and tracheal suctioning measures on the incidence of Pseudomonas aeruginosa keratitis.

Main Methods:

  • Investigations identified respiratory tract colonization with Pseudomonas aeruginosa as a precursor to ocular infections.

Related Experiment Videos

  • Recommendations for eye care and tracheal suctioning were implemented in 1991.
  • Conjunctival and respiratory tract Pseudomonas aeruginosa isolation rates were monitored before and after the implementation of preventative measures.

    • Main Results:

    • Despite a persistent high rate of respiratory tract Pseudomonas aeruginosa isolation (3.8%), the conjunctival isolation rate significantly decreased (p < 0.001) from 0.8% to 0.05% post-intervention.
    • This reduction in conjunctival colonization correlated with a significant decrease in bacterial keratitis cases.

    Conclusions:

    • Ventilated patients are at risk of ocular pathogen inoculation, with corneal exposure due to chemosis or lid damage being a key risk factor.
    • Simple preventative measures, including enhanced eye care, significantly reduced the incidence of Pseudomonas aeruginosa keratitis.
    • Further research is needed to determine optimal eye care strategies for ventilated patients to prevent this avoidable condition.