Common Organisms, Antibiotic Therapy, and Global Resistance Trends: A Systematic Review
Amir Ghaffari1 , Moein Zangiabadian1 *, Ali Ebrahimi2 , Saeid Golmohammadi1 , Mohammad Javad Nasiri1 , Hossein Hatami1
- shahid beheshti university of medical sciences, Tehran, Iran
- Shahid Beheshti University of medical sciences, Tehran, Iran
Abstract: Contact lens wearing has been increased globally during recent decades, which is one of the main risk factors for developing microbial keratitis. Microbial keratitis is a severe and dangerous condition that causes cornea inflammation. It can lead to corneal scarring and perforation or even endophthalmitis and visual loss if it remains untreated.
Among bacterial, fungal, protozoal, and viral agents which can cause microbial keratitis, bacteria are the most common cause. Therefore, in this study, we aim to find common causative bacteria, sensitivity, and resistance to antibiotics and the outcome of antibiotic therapy in contact lens-related bacterial keratitis.
Methods: A systematic search was carried out in PubMed/Medline, EMBASE, and Web
of Science for published studies and medRxiv for preprints up to February 30, 2021, and May 14, 2021, respectively. A combination of the following keywords was used: “Infection”, “Corneal infection”, “Keratitis”, “Microbial keratitis”, and “Contact lens”,Also, we used the “Contact lenses” MeSH term. Lists of references for each selected
article and relevant review articles were hand-searched to identify further studies.
Results: Twenty-six articles were included. From 1991 to 2018, 2,916 episodes of contact lens-related microbial keratitis) CLMK(with 1,642 episodes of proven bacterial keratitis have been reviewed in these studies. Studies were conducted in 17 countries with different geographical regions, and four studies were conducted in Iran, which is the
highest number of studies among these countries. According to 20 studies, the mean age of patients was 30.77 years. Females with 61.87% were more than males in 19 studies. A percentage of 92.3% of patients used soft contact lenses, and 7.7% of patients used hard contact lenses (including RGP), according to 16 studies. Pseudomonas aeruginosa,
Staphylococcus spp., and Serratia marcescens were the three most common bacteriaisolated from samples of patients with contact lens-related bacterial keratitis.
Overall, isolated bacteria were most sensitive to fluoroquinolones and aminoglycosides, especially ciprofloxacin and gentamicin respectively, and most resistant against penicillin and cephalosporins especially cefazolin and chloramphenicol. Almost all patients responded well to antibiotic therapy, with some exceptions that needed further
surgical interventions.
Conclusion: Antibiotics are efficient for treating almost all patients with contact lensrelated bacterial keratitis if they are appropriately chosen based on common germs in every geographical region and the sensitivity and resistance of these germs against them
