Fauze A Goncalves MS Thiago L Genaro MS Mariana VS Gomes MS Fabiana K Kashiwabuchi MD Flavia P Soares MD Gildaacutesio Almeida MD

The authors have no financial interest in the subject matter of this poster

To determine risk factorsrisk factors

microbiological profilemicrobiological profile and

antimicrobial susceptibilityantimicrobial susceptibility of fungal

and bacterial keratitis in two core

ophthalmology services in Satildeo Joseacute

do Rio Preto state of

Satildeo Paulo Brazil

We investigated 37 patients with clinical diagnosis of infectious keratitis and 37 volunteers with no signs or symptoms of eye infection between June 2008 and June 2009

Study design case-control study

Results were assessed using the Fisher and Pearson chi-square tests

Questionnaire

Keratitis Group

Control Group

Two swab samples from

the edge of the ulcer

Two swab samples from

the conjunctiva

Bacterioscopy + direct examination + pathogen identification

Antimicrobial sensitivity tests - disk diffusion methodology - CLSI - 2009

Antimicrobial tests Doxycycline Vancomycin Sulpha Chloramphenicol Amikacin Ciprofloxacin Levofloxacin Cefalotin Tobramycin and Ceftriaxone

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

To determine risk factorsrisk factors

microbiological profilemicrobiological profile and

antimicrobial susceptibilityantimicrobial susceptibility of fungal

and bacterial keratitis in two core

ophthalmology services in Satildeo Joseacute

do Rio Preto state of

Satildeo Paulo Brazil

We investigated 37 patients with clinical diagnosis of infectious keratitis and 37 volunteers with no signs or symptoms of eye infection between June 2008 and June 2009

Study design case-control study

Results were assessed using the Fisher and Pearson chi-square tests

Questionnaire

Keratitis Group

Control Group

Two swab samples from

the edge of the ulcer

Two swab samples from

the conjunctiva

Bacterioscopy + direct examination + pathogen identification

Antimicrobial sensitivity tests - disk diffusion methodology - CLSI - 2009

Antimicrobial tests Doxycycline Vancomycin Sulpha Chloramphenicol Amikacin Ciprofloxacin Levofloxacin Cefalotin Tobramycin and Ceftriaxone

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

We investigated 37 patients with clinical diagnosis of infectious keratitis and 37 volunteers with no signs or symptoms of eye infection between June 2008 and June 2009

Study design case-control study

Results were assessed using the Fisher and Pearson chi-square tests

Questionnaire

Keratitis Group

Control Group

Two swab samples from

the edge of the ulcer

Two swab samples from

the conjunctiva

Bacterioscopy + direct examination + pathogen identification

Antimicrobial sensitivity tests - disk diffusion methodology - CLSI - 2009

Antimicrobial tests Doxycycline Vancomycin Sulpha Chloramphenicol Amikacin Ciprofloxacin Levofloxacin Cefalotin Tobramycin and Ceftriaxone

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Questionnaire

Keratitis Group

Control Group

Two swab samples from

the edge of the ulcer

Two swab samples from

the conjunctiva

Bacterioscopy + direct examination + pathogen identification

Antimicrobial sensitivity tests - disk diffusion methodology - CLSI - 2009

Antimicrobial tests Doxycycline Vancomycin Sulpha Chloramphenicol Amikacin Ciprofloxacin Levofloxacin Cefalotin Tobramycin and Ceftriaxone

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Bacterioscopy + direct examination + pathogen identification

Antimicrobial sensitivity tests - disk diffusion methodology - CLSI - 2009

Antimicrobial tests Doxycycline Vancomycin Sulpha Chloramphenicol Amikacin Ciprofloxacin Levofloxacin Cefalotin Tobramycin and Ceftriaxone

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Mean age of patients with keratitis 524 years subjects were mostly males (784)

None of the patients in both groups were user of contact lenses

Contact with rural environments smoking alcohol consumption recent eye surgery and eye trauma were the statistically significant risk factors identified when compared to the control group (p lt 005)

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Coagulase-negative Staphylococci (CoNS) were the most common pothogens in keratitis and control group Keratitis group

Staphylococcus Warnerii was the major CoNS specie found (579)

Fungal agents were found in

189 of samples with special highlight to

Fusarium spp in 714

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Assessed according to chi-square test

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Table 1 ndash Comparative analyzes of risk factors between keratitis group and control group

Risk FactorsKeratitis

groupN = 37

Control GroupN = 37

P Odds Ratio(CI 95)

Contact with rural

environments24 11 00049

436 (164-1158)

Smoking 18 6 00057489 (165 ndash 1450)

Alcohol addiction

20 9 00165366 (136 ndash 986)

Recent eye surgery

13 1 00006195 (239 ndash

15901)

Ocular Trauma 15 1 000012455 (303 ndash

19897)

Assessed according to Fisher test Confidence interval 95

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

Contact with rural environment smoking alcohol consumption ocular trauma and previous eye surgery were significant risk factors to keratitis

CoNS agents were the most frequently identified pathogens in both the keratitis and control group

Noteworthy results of bacterial analysis include 15 resistance to moxifloxacin and 10 to cephtriaxone in the keratitis group

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28

1) Teixeira MF Almeida Jr GC Rodrigues ML Kamimoto PS Kashiwabuchi LK Resultados e indicaccedilotildees de ceratoplastias penetrantes realizadas por meacutedicos em treinamento num paiacutes em desenvolvimento Arq Bras Oftalmol 200164(6) 557-61 2) Flores VGC Dias HLR Castro RS Indicaccedilotildees para ceratoplastia penetrante no Hospital das Cliacutenicas ndash Unicamp Arq Bras Oftalmol 200770(3) 505-83) Sano FT Dantas PE Silvino WR Sanchez JZ Sano RY Adams F et al Trends in the indication for penetrating keratoplasty Arq Bras Oftalmol 200871(3)400-44) Tan DT Janardhanan P Zhou H Chan YH Htoon HM Ang LP et al Penetrating keratoplasty in Asian eyes The Singapore corneal transplant study Ophthalmology 2008115(6)975-825) Xie L Qi F Gao H Wang T Shi W Zhao J Major shift in corneal transplantation procedures in north China 5316 eyes over 12 years Br J Ophthalmol 200993(10)1291-5 6) Beckingsale P Mavrikakis I Al-Yousuf N Mavrikakis E Daya SM Penetrating keratoplasty outcomes from a corneal unit compared to national data Br J Ophthalmol 200690(6)728-31 7) Ibrahim YW Boase DL Cree IA Epidemiologic Characteristics Predisposing Factors and Microbiological Profile of Infectious corneal ulcers The Portsmouth Corneal Ulcer Study Br J Ophthalmol 200993(10)1319-248) Green M Apel A Stapleton F Risk factors and causative organisms in microbial keratitis Cornea 200827(1)22-79) Saeed A DArcy F Stack J Collum LM Power W Beatty S Risk factors microbiological findings and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland Cornea 200928(3)285-92 10) Stapleton F Keay LJ Sanfilippo PG Katiyar S Edwards KP Naduvilath T Relationship between climate disease severity and causative organism for contact lens-associated microbial keratitis in Australia Am J Ophthalmol 2007144(5)690-69811) Gopinathan U Sharma S Garg P Rao GN Review of epidemiological features microbiological diagnosis and treatment outcome of microbial keratitis Experience of over a decade Indian J Ophthalmol 200957(4)273-27912) Moriyama AS Hofling-Lima AL Contact lens-associated microbial keratitis Arq Bras Oftalmol 200871(6)32-613) Wong T Ormonde S Gamble G McGhee CN Severe infective keratitis leading to hospital admission in New Zealand Br J Ophthalmol 200387(9)1103-814) Clinical and laboratory Standards institute (CLSI) Performance standards for antimicrobial susceptibility testing nineteenth informational supplement M100-S19 CLSI Wayne PA USA 2009 15) Van der Meulen IJ Van Rooij J Nieuwendaal CP Van Cleijnenbreugel H Geerards AJ Remeijer L Age-related risk factors culture outcomes and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers Cornea 200827(5)539-4416) Yilmaz S Ozturk I Maden A Microbial keratitis in West Anatolia Turkey a retrospective review Int Ophthalmol 200727(4)261-817) Ibrahim MM Vanini R Ibrahim FM Fioriti LS Furlan EM Provinzano LM et al Epidemiologic aspects and clinical outcome of fungal keratitis in southeastern Brazil Eur J Ophthalmol 200919(3)355-61 18) Peacuterez-Balbuena AL Vanzzini-Rosano V Valadeacutez-Virgen Jde J Campos-Moumlller X Fusarium keratitis in Mexico Cornea 200928(6)626-3019) Keay L Edwards K Naduvilath T Taylor HR Snibson GR Forde K et al Microbial keratitis predisposing factors and morbidity Ophthalmology 2006113(1)109-1620) Xie L Zhong W Shi W Sun S Spectrum of fungal keratitis in north China Ophthalmology 2006113(11)1943-821) Salera CM Tanure MAG Lima WTM Campos CM Trindade FC Moreira JA Perfil das ceratites fuacutengicas no Hospital Satildeo Geraldo Belo Horizonte ndash MG Arq Bras Oftalmol 2002 65(1)9-1322) Kusbeci T Kusbeci OY Aktepe OC Yavas G Ermis SS Conjunctival flora in patients with Parkinsons disease Curr Eye Res 200934(4)251-6 23) Arantes TEF Cavalcanti RF Diniz MFA Severo MS Lins Neto J Castro CM Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery Arq Bras Oftalmol 200669(1)33-624) Oliveira RCZ Brasil OFM Arantes RS Caldas LAS Ferreira ALI Moraes Jr HV Eficaacutecia de um regime de administraccedilatildeo de antibioacuteticos toacutepicos na reduccedilatildeo da microbiota conjuntival de pacientes sadios com catarata senil Rev Bras Oftalmol 200766(4)242-725) Sirikul T Prabriputaloong T Smathivat A Chuck RS Vongthongsri A Predisposing factors and etiologic diagnosis of ulcerative keratitis Cornea 200827(3)283-726) Fong CF Hu FR Tseng CH Wang IJ Chen WL Hou YC Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan Am J Ophthalmol 2007144(5)682-8927) Zhang C Liang Y Deng S Wang Z Li R Sun X Distribution of bacterial keratitis and emerging resistance to antibiotics in China from 2001 to 2004 Clin Ophthalmol 20082(3)575-57928) Mesplieacute N Keacuterautret J Leacuteoni S Dubois V Colin J Severe bacterial keratitis and activity of fluoroquinolones J Fr Ophtalmol 200932(4) 273-629) Houmlfling-Lima AL Belfort Jr R Moeller CTA Castelo BB Sousa LB Freitas D In vitro antibiotic susceptibilities of ocular bacteria isolates from the cornea and conjunctiva to moxifloxacin gatifloxacin and other fluoroquinolones Arq Bras Oftalmol 200467(6) 883-8630) Gayoso MFA Oliveira ADD Azevedo PA Yu MCZ Houmlfling-Lima Al Francisco W Suscetibilidade antimicrobiana in vitro dos Staphylococcus coagulase negativa oculares Arq Bras Oftalmol 200770(6)924-28