Differentiation of etiologic agents of bacterial k

Authors: Jeena Mascarenhas Muthiah Srinivasan Michael Chen Revathi Rajaraman Meenakshi Ravindran Prajna Lalitha Catherine E Oldenburg Kathryn J Ray David V Glidden Stephanie Costanza Thomas M Lietman Nisha R Acharya

Publish Date: 2012/06/30

Volume: 32, Issue: 6, Pages: 531-538

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Abstract

Presenting characteristics of bacterial corneal ulcers may suggest particular causative organisms helping to guide treatment decisions before cultures become available In this study we analyze the association between presentation demographic and clinical characteristics using data collected as part of a randomized controlled clinical trial Data for this study were collected as part of the Steroids for Corneal Ulcers Trial a randomized placebocontrolled doublemasked trial All patients had a cultureproven bacterial corneal ulcer Patient history clinical examination and photography were performed in a standardized fashion at enrollment Analysis of variance or Fisher’s exact test was used to compare characteristics by organism Univariate logistic regression was used to analyze predictors of the most common organisms Five hundred patients were enrolled in the trial of whom 488 were included in this analysis The most common organism was Streptococcus pneumoniae N = 248 51  followed by Pseudomonas aeruginosa N = 110 23  Compared to other organisms P aeruginosa was significantly associated with a larger baseline infiltrate/scar size odds ratio OR 16 95  confidence interval CI 14–18 and deeper infiltrate OR 24 95  CI 15–38 S pneumoniae was significantly associated with a smaller baseline infiltrate/scar size OR 08 95  CI 07–09 and dacryocystitis OR 73 95  CI 41–133 Nocardia spp were significantly associated with longer duration of symptoms prior to presentation OR 14 95  CI 12–16 more shallow infiltrate OR 03 95  CI 02–05 and better baseline visual acuity OR 04 95  CI 02–065 Staphylococcus spp were less likely to be central in location OR 016 95  CI 008–03 Baseline characteristics of bacterial ulcers may suggest the likely etiology and guide early managementWe would like to thank the patients who enrolled in the SCUT trial and their families as well as the research staff at each of the trial sites We are also grateful for the invaluable guidance and advice of the SCUT data and safety monitoring board Marian Fisher PhD chair Anthony Aldave MD Donald Everett MA Jacqueline Glover PhD K Ananda Kannan MD Steven Kymes PhD GVS Murthy MD and Ivan Schwab MD Funding for the SCUT was from the National Eye Institute U10 EY015114 Dr Acharya is supported by a National Eye Institute K23EY017897 grant and a Research to Prevent Blindness Award The Department of Ophthalmology at UCSF is supported by a core grant from the National Eye Institute EY02162 an unrestricted grant from Research to Prevent Blindness New York NY and That Man May See Inc San Francisco CA USA

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