Microbiology and Immunology Group
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A Fresh Look at Risk Factors for Pseudomonas Keratitis: Results of a Large Case Series at a Tertiary Eye Center from 2006-2019
Rikki Enzor, MD, PhD, Regis Kowalski MS M(ASCP), Zaid Safiullah BS,
Robert Shanks PhD, Cholappadi Sundar-Raj OD, Alex Mammen MD, Vishal Jhanji MD
University of Pittsburgh Medical Center, Department of Ophthalmology, Pittsburgh, PA
Purpose: Pseudomonas aeruginosa keratitis (PAK) is a vision-threatening corneal infection, which may be prevented by avoidance of modifiable risk factors (RF). In this large retrospective case series, we sought to identify RF for PAK at a tertiary eye center.
Methods: IRB approval was obtained, and charts were reviewed for all patients with ocular cultures positive for Pseudomonas from 2006-2019. Culture-positive PAK was found in 209 eyes of 203 patients.
Results: We found that 75% of patients with PAK were contact lens (CL) wearers. Among CL wearers, 72% reported poor hygiene including sleeping in CL (50% of CL wearers), extending wear beyond the recommended timeframe (11% of CL wearers), and/or exposing CL to water (29% of CL wearers). Interestingly, 11% of CL wearers with PAK reported wearing night-day CL which are FDA approved for overnight and extended wear, with the majority of these patients reporting appropriate use including overnight wear. Other RF identified in our study included recent corneal epithelial defect (5%), ocular foreign body or trauma (11%), and topical steroid use (8%).
Conclusion: Consistent with previous studies, CL wear was the strongest modifiable RF for PAK in our study, with overnight wear posing the highest risk among CL-related behaviors. Interestingly, a relatively high percentage of the CL wearers in our study reported use of extended wear CL. Given that only 10% of CL wearers in the U.S. reported use of extended wear CL in the International Survey of Contact Lens Prescribing for Extended Wear, published in 2012, our results raise the concern that overnight wear of extended wear CL may present a significant risk of developing vision-threatening PAK.
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