Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review

Clin Exp Ophthalmol. 2019 Aug;47(6):726-732. doi: 10.1111/ceo.13484. Epub 2019 May 1.

Abstract

Importance: Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community.

Background: Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK.

Design: Retrospective review of clinical records of patients with MK.

Participants: All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database.

Methods: Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection.

Main outcome measures: Yearly rate of CLMK.

Results: Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.

Keywords: contact lens; cornea; keratitis.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / isolation & purification
  • Contact Lenses / microbiology
  • Contact Lenses / trends*
  • Corneal Ulcer / drug therapy
  • Corneal Ulcer / epidemiology*
  • Corneal Ulcer / microbiology
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / epidemiology*
  • Eye Infections, Fungal / microbiology
  • Female
  • Fluoroquinolones / therapeutic use
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Queensland / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Fluoroquinolones