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Empirical treatment of bacterial keratitis: an international survey of corneal specialists
  1. Ariana Austin1,
  2. Julie Schallhorn1,
  3. Mike Geske1,2,
  4. Mark Mannis3,
  5. Tom Lietman1,4,
  6. Jennifer Rose-Nussbaumer1,2
  1. 1 Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
  2. 2 Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
  3. 3 Department of Ophthalmology & Vision Science, University of California, Davis, Davis, California, USA
  4. 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jennifer Rose-Nussbaumer; jennifer.rose-nussbaumer{at}ucsf.edu

Abstract

Background/aims New antibiotic agents and changing susceptibility patterns may have changed the empirical treatment of bacterial keratitis. Our objective in this study was to survey cornea specialists’ practice patterns in the initial treatment of bacterial ulcers.

Methods This study consisted of a short online survey emailed to members of the Cornea Society listserv for an international sample of cornea specialists. Data collection began July 2014 and ended October 2014.

Results A total of 1009 surveys were emailed, and we received 140 (14%) responses. The majority of US clinicians surveyed (n=83, 80%) chose fortified antibiotics empirically, with 55% (n=57) selecting fortified vancomycin and 16% (n=17) using fluoroquinolone alone. International respondents were twice as likely to use fluoroquinolone monotherapy (31%, n=11, p=0.07) and less likely to use fortified vancomycin (33%, n=12, p=0.03). Forty-five per cent (n=46) of US respondents reported that their initial antibiotic choice covered methicillin-resistant Staphylococcus aureus, compared with 22% (n=8) of international respondents (p<0.01). Overall, respondents who were concerned about availability of antibiotics and toxicity were 20.86 (p<0.001) and 7.48 (p<0.001) times more likely to choose fluoroquinolone monotherapy, respectively. If respondents’ primary considerations were broad spectrum coverage or antibiotic resistance they had 7.10 (p<0.001) and 12.51 (p<0.001) times the odds of using fortified vancomycin, respectively.

Conclusion Practice patterns for the initial treatment of bacterial keratitis vary with clinicians in the USA being more likely to use fortified antibiotics versus fluoroquinolone monotherapy and more concerned with resistant organisms than their international peers.

  • Cornea
  • Infection

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Acknowledgements Individual support for this study came from K23 EY025025 (JRN), an unrestricted grant from the Peirles Foundation (JRN) and an unrestricted grant from Research to Prevent Blindness (JRN).

  • Contributors Corresponding author JR-N contributed to study design and implementation, data analysis and writing of this manuscript. AA contributed to data analysis and writing of the manuscript. JS and MG were involved in design and implementation of this study. MM contributed to study design and implementation as well as editing of the manuscript. TL contributed to the design of the study, data analysis and editing of the manuscript.

  • Funding There are no conflicts of interest to declare. Corresponding author Dr Jennifer Rose-Nussbaumer contributed to study design and implementation, data analysis, and writing of this manuscript. Ariana Austin contributed to data analysis and writing of the manuscript. Dr Julie Schallhorn and Dr Mike Geske were involved in design and implementation of this study. Dr Mark Mannis contributed to study design and implementation as well as editing of the manuscript. Dr Tom Lietman contributed to the design of the study, data analysis, and editing of the manuscript.

  • Ethics approval University of California, San Francisco Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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