12-Year Analysis of Incidence, Microbiological Profiles and
In Vitro Antimicrobial Susceptibility of Infectious Keratitis:
The Nottingham Infectious Keratitis Study
Ting DSJ, Ho CS, Cairns J, et al. Br J Ophtalmol 2021; 105:328-333
Avizena Muhammad Zamzam
Medical Staff Group of Ophtalmology
Sriwijaya University
Dr. Mohammad Hoesin Hospital
2021
INTRODUCTION
Major cause of corneal blindness
1 Globally 5% of all blindness
INFECTIOUS
KERATITIS
2 Common case of sight threatening
3 Diverse causative microorganism
INTRODUCTION
4 Diagnostic • Clinical characteristic
Findings • Microbiological investigation
INFECTIOUS
KERATITIS
Only 2 studies reported
5 in United Kingdom
PURPOSE
OBJECTIVE
To provide an up to date and comprehensive analysis
on the incidence, microbiological profiles and in vitro
antimicrobial susceptibility and resistance of IK
in Nottingham UK, and compare to recent literatures
METHODS
DESIGN
STUDY DESIGN
Cohort retrospective
LOCATION OF INTERVENTION
STUDY • Diagnostic guideline
Queen’s Medical • Corneal scrapping
Center, Nottingham, • Culture and
United Kingdom antibiotics
susceptibility testing
METHODS
SUBJECT
Patients with IK + corneal scraping ;
July 2007 until October 2019 ;
Queen’s Medical Centre (QMC), Nottingham, UK.
• Local departmental guideline • Unresponsive treatment after
for IK first culture
• European Committee guideline
for in vitro microbiological
investigation • Negative result from re-scraping
INCLUSION CRITERIA EXCLUSION CRITERIA
METHODS
INTERVENTION
QUEEN’S MEDICAL CENTER
2007-2013
LOCAL MICROBIOLOGICAL 12 year
and
study period 2014-2019
ELECTRONIC DATABASE
LOCAL DEPARTMENTAL GUIDELINE FOR IK
- CORNEAL SCRAPPING
- MICROBIOLOGICAL INVESTIGATION
- CULTURE
- SUSCEPTIBILITY & RESISTANCE TESTING
METHODS
INTERVENTION
The identity of the microorganisms was confirmed
through standard culture and bacteriology tests
1400 – 67 = 1333 Total
cases
Ethical Approval?
Waived by the local research ethics committee
and classified as a service evaluation
METHODS
STATISTIC ANALYTICAL METHODS
PEARSON’S
CATEGORICAL CHI-SQUARE
VARIABLES OR
FISHER’S
EXACT TEST
SPSS V.26.0
UNPAIRED
CONTINUOUS T-TEST
VARIABLES OR
MANN-
WHITNEY
RESULTS
PROFILE
Description Susceptibility
Causative
and and
Microorganism
Incidences Resistence
RESULTS
DESCRIPTION AND INCIDENCE
RESULTS
CAUSATIVE MICROORGANISM
Significant p values
(<0.05)
RESULTS
SUSCEPTIBILITY AND RESISTENCE
Significant p values
(<0.05)
DISCUSSION
INCIDENCE
West Scotland
West Scotland
Nottingham, UK
3,6 per 100.000
population/ year Portsmouth, UK
Nottingham, UK
Nepal
34,7 per 100.000 India
population/ year
Portsmouth, UK India and Nepal
40,1-52,1 per 100.000 1,1-8,0 per 1000
population/ year
population/ year
DISCUSSION
MICROBIOLOGICAL PROFILE
Developed Developing
Country Country
Bacteria Fungi
Occupational risk, agricultural industry, use of contact
lens, environmental, hygiene, education, access to
healthcare
DISCUSSION
MICROBIOLOGICAL PROFILE
Main causative : Pseudomonas sp.
• Several studies : Coagulase negative Staphylococcus
Increase in trend of Mmoraxella keratitis
• Similar to other regions in UK Potentially endemic
issue
Culture positivity rate 37.7%
• Comparable but lower to some studies
DISCUSSION
ANTIBIOTIC SUSCEPTIBILITY AND RESISTANCE
Antimicrobal resistance (AMR) Emerging as a global health threat of 21st
century
MDR MRSA
0,3% or 4 cases Relatively low 0,07% or 1 case
Increase of penisillin resistance
Most of bacterial isolated are susceptible to current
broad spectrum AB
Provide good treatment coverage in most IK cases
DISCUSSION
STRENGTH AND LIMITATION
DISCUSSION
CONCLUSION
IK represents a relatively common and
persistent burden in the UK
The reported incidence is likely to be
underestimated
Current broad-spectrum antimicrobial
treatment provides good coverage for IK
CRITICAL APPRAISAL
CRITICAL APPRAISAL
CRITICAL APPRAISAL SHEET
• All patient with IK and
POPULATION underwent corneal scrapping
• Culture and antibiotics
INTERVENTION susceptibility testing
COMPARISON • -
OUTCOME • Good coverage of treatment
CRITICAL APPRAISAL
Is the background of the study clearly stated?
Yes, the references from earlier studies
included and the topic coverage related to
the area under discussion and
express the components of what was
previously known.
CRITICAL APPRAISAL
What is the main problem of this study?
The main problem is the literature for this
topic is limited, especially in the designed
area of study while IK still becoming the
major threat of corneal blindness
CRITICAL APPRAISAL
What is the objective of this study?
The objective is to provide an up to
date data between 3 main
sub-topics of IK in Nottingham, UK
CRITICAL APPRAISAL
What is the type of this study?
Observational, Cohort retrospective
CRITICAL APPRAISAL
What are the conclusions of this study?
This study is considered to have good
validity with moderate risk of bias.
The outcome itself is relevant
to patient care but only
applicable in a developed country.
THANK YOU
