12400: Pediatric Infectious Keratitis at Tertiary Referral Centers in

Download Report

Transcript 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.
References
1. Zaidman G. The pediatric corneal infiltrate. Current Opinion in Ophthalmology. 2011;22:261–266.
2. Ameet S, Sachdev A, et al. Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature. Br J Ophthalmol. 2011;95:762-767.
3. Lisa AJ, Walline JJ, et al. Purchase of contact lenses and contact-lenses-related symptoms following the Contact Lenses in Pediatrics (CLIP) Study. Contact Lens & Anterior Eye. 2009;32:157–
163
4.Wagner H, Chalmers RL, et al. Risk Factors for Interruption to Soft Contact Lens Wear in Children and Young Adults. Optometry and Vision Science. 2011; Vol. 88, No. 8.
5. Al Otaibi AG, Allam K. Childhood microbial keratitis. Oman Journal of Ophthalmology. 2012; Vol. 5, No. 1.
6. Singh G, Palanisamy M. Multivariate Analysis of Childhood Microbial Keratitis in South India. Ann Acad Med Singapore. 2006;35:185-9
7. Hsiao CH, Yeung L, et al. Pediatric Microbial Keratitis in Taiwanese Children A Review of Hospital Cases. Arch Ophthalmol. 2007; Vol. 125.
8. Wong VWY, Lai TYY, et al. Pediatric Ocular Surface Infections: A 5-year Review of Demographics, Clinical Features, Risk Factors, Microbiological Results, and Treatment. Cornea. 2011; Vol.
30, No. 9.
9. Song X, Xu L, et al. Pediatric microbial keratitis: a tertiary hospital study. Eur J Ophthalmol. 2011;22(2) 136-141.
10. KM Holland. Cornea 3rd edition, Chapter 77, 919.
11. Al-Otaibi AG. Non-viral microbial keratitis in children. Saudi Journal of Ophthalmology. 2012;26:191–197.
12. Fraser MN, Wong Q, et al. Characteristics of an Acanthamoeba Keratitis Outbreak in British Columbia between 2003 and 2007. Ophthalmology. 2012;119:1120–1125.
13. Butler AL, Sasaki S, et al, Epidemiology of infectious corneal ulcers in Vancouver, BC. The Canadian ophthalmology meeting 2012, Toronto, Canada.
14. Stapleton F. Keay LJ. et al. Relationship Between Climate, Disease Severity, and Causative Organism for Contact Lens–Associated Microbial Keratitis in Australia, Am J Ophthalmol
2007;144:690–698.
15. Stapleton F, Carnt N. Contact lens-related microbial keratitis: how have epidemiology and genetics helped us with pathogenesis and prophylaxis. Eye. 2012;26:185–193.
16. Hammersmith KM, Cohen EJ, et al. Blepharokeratoconjunctivitis in Children. Arch Ophthalmol. 2005;123:1667-1670.
17. Jones SM, Nischal KK, et al. Visual Outcome and Corneal Changes in Children with Chronic Blepharokeratoconjunctivitis. Ophthalmology. 2007;114:2271–2280.
18.Ormerod LD, Murphree AL, Gomez DS, Schanzlin DJ, Smith RE. Microbial keratitis in children. Ophthalmology. 1986;93:449-455.
19. Cruz OA, Sabir SM, Capo H, Alfonso EC. Microbial keratitis in childhood. Ophthalmology. 1993;100:192-196.
20. Clinch TE, Plamon FE, Robinson MJ, Cohen EJ, Barron BA, Laibson PR. Microbial keratitis in children. Am J Ophthalmol. 1994;117:65-71.
21. Di Pascuale MA, Espana EM, Liu DT. Correlation of Corneal Complications with Eyelid Cicatricial Pathologies in Patients with Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Syndrome. Ophthalmology. 2005;112:904–912.
22. Keay LJ, Gower EW, Lovieno A. Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001–2007: A Multicenter Study. Ophthalmology. 2011;118:920–926.
23. Schultz DG. (2007, May 31). FDA Preliminary Public Health Notification: Acanthamoeba Keratitis Infections Potentially Related to Complete MoisturePlus Multipurpose Contact Lens
Solution Manufactured by Advanced Medical Optics (AMO). Retrieved from http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062063.htm.