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Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study

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Abstract

Purpose

The purpose of this study is to compare the predisposing factors, clinical findings, treatment results, and prognosis for polymicrobial keratitis.

Methods

In this retrospective comparative case study, we identified the cases of polymicrobial keratitis from the microbiological records (n = 649) at Balcalı Hospital, Çukurova University (Adana, Turkey; October 2010–2018). We included all the cases of infectious keratitis with two different types of microbial agents and grouped them as follows: group 1 (n = 25), bacterium–fungus coexistence; group 2 (n = 12), herpes simplex virus (HSV) or Acanthamoeba with bacterial infection; and group 3 (n = 7), HSV or Acanthamoeba with fungal infection. We compared the clinical and microbiological characteristics, and treatment outcomes among the groups.

Results

In our study, we found that 44 infectious keratitis cases (6.7%) were of polymicrobial nature. The mean follow-up period was 11.4 ± 17.8 months. In total, 17 different bacteria along with 3 different fungi, HSV, and Acanthamoeba were isolated. The most common bacterium was Staphylococcus epidermidis (25%). Most of the fungal pathogens were filamentous. Patients with initial treatment failure and requiring surgical intervention had larger infiltrates (p = 0.023, p = 0.003, respectively) than other patients. Older age was associated with delayed recovery and poor visual prognosis.

Conclusions

Bacterial–fungus coexistence is the most common combination among patients, but other combinations should also be considered for suspected polymicrobial etiology. The corneal infiltrate size may be an important indicator of the course of disease and response to treatment. A closer and longer follow-up period should be planned for older patients.

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Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. School of Medicine, Department of Ophthalmology, Cukurova University, Adana, Turkey

    Ibrahim Inan Harbiyeli, Elif Erdem, Burcu Cam & Meltem Yagmur

  2. Department of Ophthalmology, Muradiye State Hospital, Van, Turkey

    Oguzhan Oruz

  3. School of Medicine, Department of Parasitology, Cukurova University, Adana, Turkey

    Mehtap Demirkazik

  4. School of Medicine, Department of Pathology, Cukurova University, Adana, Turkey

    Arbil Acikalin

  5. School of Medicine, Department of Medical Microbiology, Cukurova University, Adana, Turkey

    Filiz Kibar

  6. School of Medicine, Department of Microbiology, Division of Mycology, Cukurova University, Adana, Turkey

    Macit Ilkit

  7. School of Medicine, Department of Microbiology, Division of Virology, Cukurova University, Adana, Turkey

    Fugen Yarkin

Authors
  1. Ibrahim Inan Harbiyeli
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  2. Oguzhan Oruz
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  3. Elif Erdem
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  10. Meltem Yagmur
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by IIH, OO, and BC. The first draft of the manuscript was written by IIH and EE. Review and editing were performed by MD, AA, FK, and FY. Supervision was performed by MI and MY. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ibrahim Inan Harbiyeli.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare that are relevant to the content of this article.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Çukurova University Faculty of Medicine (decision no. 1237).

Consent to participate

This retrospective study was conducted on already available data.

Consent for publication

This retrospective study was conducted on already available data.

Meeting presentation

Some of the data included in this article were presented at the 36th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), Vienna, Austria, 22–26 September 2018.

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Harbiyeli, I.I., Oruz, O., Erdem, E. et al. Clinical aspects and prognosis of polymicrobial keratitis caused by different microbial combinations: a retrospective comparative case study. Int Ophthalmol 41, 3849–3860 (2021). https://doi.org/10.1007/s10792-021-01955-2

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  • DOI: https://doi.org/10.1007/s10792-021-01955-2

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