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| LETTER TO THE EDITOR |
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| Year : 2019 | Volume
: 67
| Issue : 9 | Page : 1508-1509 |
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Bacterial isolates in microbial keratitis: Three-year trend analysis from North India
Manisha Acharya1, Javed Hussain Farooqui1, Aastha Singh1, Arpan Gandhi2, Umang Mathur1
1 Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, New Delhi, India
2 Laboratory Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| Date of Web Publication | 22-Aug-2019 |
Correspondence Address:
Dr. Manisha Acharya
Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, 5027, Kedar Nath Marg, Daryaganj, New Delhi - 110 002
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijo.IJO_678_19
How to cite this article:
Acharya M, Farooqui JH, Singh A, Gandhi A, Mathur U. Bacterial isolates in microbial keratitis: Three-year trend analysis from North India. Indian J Ophthalmol 2019;67:1508-9 |
Sir,
We read with great interest the article titled “Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years” by Das et al.[1] As a tertiary eye care provider and one of the biggest cornea departments in north India, we congratulate the authors for their brilliant work, would like to use this opportunity to reflect upon, and compare the microbial profile and antibiotic sensitivity seen in our practice. We agree with the authors that local epidemiological studies are required to provide evidence-based management of microbial keratitis,[1] and hence, wanted to add our data from north India to their study, to give a pan India perspective to our readers. What Das et al.[1] have demonstrated beautifully is that a good microbiological evaluation of infective keratitis is invaluable for correct diagnosis and appropriate therapy. This may also improve the chances of a successful clinical outcome. As a protocol, treatment should be initiated from smears, without waiting for the results of culture and sensitivity. Initial empirical therapy for bacterial keratitis should involve frequent instillation of broad-spectrum antibiotic drops. Appropriately, targeted antimicrobial therapy backed by microbiological investigations should be the first step, and if resistance to primary therapy is noted, microbiology results need to be reviewed and changed to appropriate antimicrobials.
At our institute, a retrospective audit was done to review collective microbiological profile and sensitivity pattern of all ocular bacterial infections of 3 years, from January 2015 to December 2017. A total of 1,169 cultures in this period grew bacteria. Gram-positive bacteria represented 76.6% (n = 895) of all isolates, whereas 274 (23.4%) cultures isolated gram-negative bacteria. The most common gram-positive bacteria isolated were coagulase-negative Staphylococcus (56.2%), whereas Pseudomonas spp. (64.2%) was the most commonly isolated gram-negative bacteria. Coagulase-negative staphylococcus in our study depicted variable sensitivity to cephalosporins (70.8%) and fluoroquinolones (92.6%). Consistent with the authors' findings,[1] 100% of our Staphylococcus aureus cases were sensitive to vancomycin, with relatively poor sensitivity to ciprofloxacin (68.6%). Authors found that cephalosporins worked best for Streptococcus, however, in our group, maximum sensitivity was seen for moxifloxacin (92.9%). Third generation cephalosporins, vancomycin, and moxifloxacin had good sensitivity for all gram-positive bacteria. The various bacteria and their sensitivity patterns are depicted in [Table 1] and [Table 2]. | Table 1: Antibiotic Sensitivity Pattern for Isolated Gram-positive Bacteria
Click here to view |
 | Table 2: Antibiotic Sensitivity Pattern for Isolated Gram-negative Bacteria
Click here to view |
Sensitivity pattern for Pseudomonas spp., the most common isolated gram-negative bacteria, was less than 60% for all the five antibiotics tested in our analysis and is thus alarming. Our findings were not consistent with the authors' findings,[1] where they found more than 80% sensitivity for aminoglycosides and more than 85% sensitivity for fluoroquinolones in the Pseudomonas group. Worrying trends of multi-drug resistant Psuedomonas spp. are already showing around the world,[2],[3] a reflection of which, we are also beginning to see in our clinics. Other gram-negative bacteria such as Moraxella More Details, other enterics, and gram-negative rods displayed good susceptibility to fluoroquinolones and various aminoglycosides.
Our results are consistent with the authors' study, demonstrating predominance of gram-positive bacteria among ocular infections. Similar microbiological profile has been reported in studies from other geographical regions in India [4] and the west.[5]
Finally, we would like to echo authors' recommendations about the importance of cultures for identifying organism and their sensitivity pattern. Integrating microbiological work-up and avoiding “cocktail therapy” for microbial keratitis is the only way forward in this era of ever increasing drug resistance.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Das S, Samantaray R, Mallick A, Sahu SK, Sharma S. Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years. Indian J Ophthalmol 2019;67:49-53.  [ PUBMED] [Full text] |
| 2. | Ku JY, Kim P, Tong J, Wechsler A, McCluskey P. Multiresistant Pseudomonas keratitis. Clin Exp Ophthalmol 2010;38:818-9. |
| 3. | Chatterjee S, Agrawal D. Multi-drug resistant Pseudomonas aeruginosa keratitis and its effective treatment with topical colistimethate. Indian J Ophthalmol 2016;64:153-7. [ PUBMED] [Full text] |
| 4. | Tewari A, Sood N, Vegad M, Mehta DC. Epidemiological and microbiological profile of infective keratitis in Ahmedabad. Indian J Ophthalmol 2012;60:267-72. [Full text] |
| 5. | Peng MY, Cevallos V, McLeod SD, Lietman TM, Rose-Nussbaumer J. Bacterial keratitis: Isolated organisms and antibiotic resistance patterns in San Francisco. Cornea 2018;37:84-7. |
[Table 1], [Table 2]
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