Elsevier

Ophthalmology

Volume 103, Issue 1, January 1996, Pages 23-28
Ophthalmology

The Role of Smears, Cultures, and Antibiotic Sensitivity Testing in the Management of Suspected Infectious Keratitis

https://doi.org/10.1016/S0161-6420(96)30738-0Get rights and content

Purpose: To examine the role of routine smears, cultures, and antibiotic sensitivity testing in the treatment of suspected infectious keratitis.

Methods: A retrospective chart and laboratory data review was performed for 81 consecutive patients seen in the Los Angeles County/University of Southern California Department of Ophthalmology between June 1991 and December 1993 with a primary diagnosis of community-acquired infectious keratitis. No patients were treated with antibiotics before evaluation in the authors' department, and all underwent corneal scrapings for gram-stain and bacterial, fungal, and mycobacterium cultures. Ulcers were classified as moderate or severe. All initially were treated as inpatients with a regimen including fortified cefazolin and a fortified aminoglycoside.

Results: Of 81 patients, 74 ulcers were either culture- negative (n = 18) or grew bacteria (n = 56). Fungal infection was suggested in seven patients. Of the nonfungal ulcers, 33 were classified as moderate, and 41 as severe; all moderate ulcers improved without requiring a modification in antibiotic treatment, whereas 3 severe ulcers required a change in treatment.

Conclusion: Most community-acquired bacterial ulcers resolve with broad spectrum empiric therapy. Alternatives to universal culture and sensitivity testing that might be considered include selectively performing cultures for more severe or suspected non-bacterial ulcers or routinely obtaining cultures in all cases, but pursuing identification and sensitivity studies only when those data are required for therapy modification.

References (24)

  • TJ Liesegang

    Bacterial and fungal keratitis

  • D Amsterdam et al.

    Diagnostic technologies in clinical microbiology

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    Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York.

    **

    Dr. McLeod currently is affiliated with the Illinois Eye and Ear Infirmary and the University of Illinois at Chicago Department of Ophthalmology and Visual Sciences, Chicago.

    ***

    Dr. McDonnell is a Research to Prevent Blindness William and Mary Greve International Research Scholar.

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