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      Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases.

      The British Journal of Ophthalmology
      Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, therapeutic use, Bacterial Infections, drug therapy, microbiology, Child, Child, Preschool, Contact Lenses, adverse effects, Cornea, Corneal Diseases, Eye Injuries, Female, Humans, Infant, Keratitis, Male, Middle Aged, Pseudomonas Infections, Retrospective Studies, Risk Factors, Staphylococcal Infections, Suppuration, Treatment Outcome

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          To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice. A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected. 300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome. Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment.

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