Pseudomonas aeruginosa keratitis in a tertiary referral center: a decade of clinical insights and therapeutic challenges

TL;DR

This study examines Pseudomonas aeruginosa eye infections over ten years, highlighting risk factors, treatment challenges, and outcomes in a major hospital.

Contribution

The study provides a decade-long analysis of Pseudomonas aeruginosa keratitis cases in a tertiary center, identifying risk factors and antibiotic resistance trends.

Findings

Trauma was the most common risk factor, with corneal perforation affecting 23.84% of patients.

High antibiotic sensitivity was observed for amikacin, ciprofloxacin, and ceftazidime.

Advanced age and diabetes were linked to worse visual outcomes.

Abstract

To evaluate the clinical characteristics, risk factors, antimicrobial resistance patterns, and outcomes of Pseudomonas aeruginosa keratitis in patients referred to a tertiary eye care center over a ten-year period.

In this retrospective study, medical records of patients with culture-confirmed Pseudomonas aeruginosa keratitis between 2012 and 2022 at Farabi Eye Hospital, Tehran, were reviewed. Data collected included demographic and clinical features, antimicrobial susceptibility results, treatment modalities, and outcomes up to six months of follow-up.

A total of 172 patients were included. The mean age was 52.33 ± 22.01 years, with a nearly balanced gender distribution (49.42% male, 50.58% female). Trauma was the most common predisposing factor (30.23%). Corneal perforation occurred in 23.84% and endophthalmitis in 13.95% of patients. Surgical intervention was required in 68.6% of patients, with penetrating keratoplasty (PKP) performed in 35.5%. Advanced age, worse baseline best corrected visual acuity (BCVA), diabetes mellites, and corneal perforation were significantly associated with poorer visual outcomes. Antimicrobial susceptibility testing revealed preserved sensitivity to amikacin (95.93%), ciprofloxacin (95.93%), ceftazidime (95.35%), and gentamicin (92.44%), while high resistance rates were noted for chloramphenicol (48.26%) and cefazolin (59.30%).

Pseudomonas aeruginosa keratitis remains a severe, sight-threatening condition associated with significant surgical burden and suboptimal visual outcomes. Despite retained sensitivity to key antibiotics, high rates of corneal perforation and endophthalmitis emphasize the need for timely diagnosis and aggressive management. Future prospective, multicenter studies with longer follow-up are warranted to better define long-term outcomes and guide treatment strategies.