Download 12400: Pediatric Infectious Keratitis at Tertiary Referral Centers in

Pediatric Infectious Keratitis
at Tertiary Referral Centers in
Vancouver, British Columbia
Gelareh S. Noureddin, MD, Sachiko Sasaki, MD, Andrea L.
Butler, MD, Christopher J. Lyons, MD FRCSC, Simon P.
Holland, MD FRCSC, Sonia N. Yeung, MD PhD FRCSC
The authors have no financial interests to disclose.
Introduction
• Microbial keratitis is a potentially sight-threatening
condition.
• In children, it may lead to amblyopia secondary to corneal
scarring.
• Prompt and effective treatment results in better visual
outcomes.
• Regional patterns of infection and antibiotic sensitivity are
helpful in making treatment decisions.
Purpose
• To report the clinical and microbiological
profiles of pediatric patients with infectious
keratitis requiring corneal scraping for
diagnosis in Vancouver, British Columbia (a
moderate oceanic climate)
Methods
• Observational case series
• Microbiology results and medical records of 17
eyes with microbial keratitis in 16 children aged
17 years or younger were retrospectively
reviewed.
• All patients had corneal scraping performed
between May 2006 and April 2011.
Results: Demographics and Clinical
Features
• 17 corneal scrapings in 16 children
– One child with Stevens-Johnson Syndrome (SJS)
developed a second corneal ulcer during the study period;
both ulcers have been included.
• Mean age: 11 ±5.7 years (range 1-17)
• Ulcers most commonly large (>4mm) and mid-
peripheral in location
• Most common presenting symptom was pain (65%)
Results: Predisposing Factors
• 9/17 cases had pre-existing ocular surface condition
– Blepharokeratoconjunctivitis (BKC); n=3
– Stevens-Johnson (SJS); n=3
– Complex ocular history with previous surgery; n=3
• 6/17 cases related to contact lens wear
• 1 case foreign body
• 1 case previous HSV keratitis
Results: Microbiology
Microorganism Incidence
Gram Positive Bacteria
Gram Negative Bacteria
Fungus
Parasite
Culture negative
Polymicrobial
Microorganism
CL Wearer Non-CL Wearer
Bacillus
1
Coagulase-negative S. epidermidis
1
4
Corynebacterium
1
1
S. pneumoniae
1
S. viridans
1
1
H. influenzae
1
P. aeruginosa
2
Aspergillus fumigatus
1
Acanthamoeba
4
4
2
2
Results: Antibiotic Sensitivity
Antibiotic Susceptibilities and Resistance
Class
Antibiotic
Ciprofloxacin
Levofloxacin
Fluoroquinolone
Moxifloxacin
Ofloxacin
Glycopeptide
Vancomycin
Gentamicin
Aminoglycoside
Tobramycin
Amphenicol
Chloramphenicol
Susceptibility
Gram +ve
Gram -ve
2
2
1
2
3
2
7
4
2
3
2
5
1
Resistance
Gram +ve
Gram -ve
1
1
1
Results: Outcome
• Visual acuity ≥20/60 in 9/16 patients = 56%
• 3 patients required subsequent surgery for
corneal scarring:
– 2x penetrating keratoplasty
– 1x DALK
Discussion
• Most common isolate was coagulase negative S.
epidermidis; similar to other studies
• Acanthamoeba in 4/6 contact lens wearers
– Related to use of contact lens solution later recalled
by FDA in 2007
• Pseudomonas in 2/6 contact lens wearers
– Important to ensure antibiotic coverage in CL
keratitis
Conclusion
• Contact lens wear and pre-existing ocular surface
conditions are important risk factors for the development
of infectious keratitis in our population.
• Knowledge of regional patterns of infection and antibiotic
sensitivity/resistance allow for effective management and
better visual outcomes for children.
• We recommend other groups perform profiling of this
condition in their respective localities.
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