# Demographic and Microbiological Profile of Corneal Ulcers in Eastern India

## TL;DR

This study examines corneal ulcers in eastern India, finding fungal infections more common than bacterial ones and identifying key pathogens and their drug resistance patterns.

## Contribution

The study provides updated insights into the microbial profile and antimicrobial susceptibility patterns of corneal ulcers in eastern India.

## Key findings

- Fungal isolates (74.51%) were more prevalent than bacterial isolates (25.49%) in corneal ulcer cases.
- Fusarium and Aspergillus were the most common fungal isolates, while Staphylococcus aureus was the most common bacterial isolate.
- Most fungal isolates were susceptible to voriconazole and amphotericin B, while bacterial isolates showed variable resistance to fluoroquinolones.

## Abstract

Purpose: To evaluate the microbiological profile of corneal ulcers presenting at a tertiary care eye hospital in eastern Uttar Pradesh (UP), India.

Methods: This retrospective, observational study included patients with corneal ulcers who underwent corneal scraping and microbiological examination of the sample from May 2014 to October 2023. The demographic details, predisposing factors, and clinical examination data of the patients were noted. Microbiology report of staining and culture (blood agar and Sabaraud’s dextrose agar) of corneal scraping sample was analyzed in percentage. Reports of antimicrobial susceptibility testing were also noted and analyzed.

Results: A total of 695 corneal scraping samples were examined during the study period. The mean age of the patients was 45.95 years. Among the patients, 412 (59.28%) were males and 283 (40.72%) were females. Among the patients, 402 (57.84%) belonged to an agricultural background. Trauma was the most common predisposing factor associated with 350 (50.36%) cases. The corneal scraping samples were stain-positive in 455 (65.47%) cases, of which, 130 (28.57%) were gram-positive and 325 (71.43%) were positive on potassium hydroxide (KOH) mount. Culture was positive in 306 (44.03%) cases, of which, bacterial isolates were found in 78 (25.49%), and fungal isolates were found in 228 (74.51%). Fusarium was the most common fungal isolate in 72 (31.58%) cases followed by Aspergillus in 60 (26.32%) cases. Among the bacterial isolates, Staphylococcus aureus was the most common in 20 (25.64%) cases followed by Pseudomonas and Streptococcus. The antimicrobial susceptibility testing showed that 47 (60.26%) of the bacterial isolates were sensitive to fluoroquinolones while the rest 31 (39.74%) were resistant. All the Staphylococcus aureus strains (including four cases of methicillin-resistant Staphylococcus aureus) were susceptible to vancomycin and linezolid, while 7 (35%) were resistant to moxifloxacin. None of the Pseudomonas strains were multidrug resistant. Among the fungal isolates, 220 (96.49%) were susceptible to voriconazole and 189 (82.89%) were sensitive to amphotericin B.

Conclusion: Fungal corneal ulcers are more common compared to bacterial ulcers in eastern India, particularly eastern UP and Bihar. This article highlights the importance of microbial testing and provides insight into the prevalent organisms and their antimicrobial susceptibility pattern in this geographic location, the knowledge of which will help clinicians in the appropriate management of these cases.