Bakterielle Keratitis

 

 Buy Article Permissions and Reprints

Zusammenfassung

Entzündliche Hornhauterkrankungen sind weltweit betrachtet eine der führenden Ursachen monokularer Erblindung. Bakterielle Infektionen stehen dabei im Vordergrund und werden bei 80 % der Patienten mit ulzerativer Keratitis angetroffen. In den letzten Jahren sind sowohl veränderte Risikosituationen als auch Veränderungen im Keimspektrum zu beobachten. Kontaktlinsen und refraktivchirurgische Hornhauteingriffe sind Faktoren, die einigen Studien zufolge an Bedeutung zugenommen haben. Problemkeime wie Pseudomonas spp. und atypische Mykobakterien sind vor allem bei diesen Patienten nachweisbar. Demgegenüber wird die bakterielle Keratitis nach Trauma seltener beobachtet. Die breite, oft ungezielte Anwendung hochwirksamer antimikrobieller Wirkstoffe, vor allem von Fluorchinolonen, wird als ein Faktor für den Wandel des Keimspektrums angenommen. Aufgrund des oft problematischen Verlaufs der Keratitis und um eine gezielte, effektive Therapie einzuleiten, ist ein Erregernachweis erforderlich. Die Möglichkeiten der Diagnostik sind in den letzten Jahren durch molekularbiologische Techniken erweitert worden, ohne jedoch etablierte Verfahren ersetzen zu können. Ziel dieses Beitrags ist es, einen Überblick zu aktuellen Aspekten der bakteriellen Keratitis zu bieten.

Abstract

Worldwide inflammatory corneal diseases are considered to be one of the leading causes of monocular blindness. Bacterial infectious are still predominant and are found in 80 % of patients with ulcerative keratitis. In recent years, both changes in risk conditions and changes in the bacterial spectrum can be observed. Contact lenses and refractive surgery are factors that have increased in importance according to some studies. Microorganisms especially Pseudomonas spp. and atypical mycobacteria are detectable in these patients. In contrast, the bacterial keratitis is observed less frequently after trauma. The broad, often unsighted use of highly effective antimicrobial agents, especially of fluoroquinolones is assumed to be a factor in the transformation of the microbial spectrum. Due to the frequent course of keratitis and a targeted, effective therapy to initiate a pathogen is desirable. The possibilities of diagnostics have been expanded in recent years by molecular biological techniques, but cannot replace established methods. The aim of this paper is to provide a positioning on current aspects of bacterial keratitis.

• Literatur

• 1 Shah A, Sachdev A, Coggon D et al. Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature. Br J Ophthalmol 2011; 95: 762-767
  CrossrefPubMedGoogle Scholar
• 2 Ahn M, Yoon KC, Ryu SK et al. Clinical aspects and prognosis of mixed microbial (bacterial and fungal) keratitis. Cornea 2011; 30: 409-413
  CrossrefPubMedGoogle Scholar
• 3 Amescua G, Miller D, Alfonso EC. What is causing the corneal ulcer? Management strategies for unresponsive corneal ulceration. Eye (Lond) 2012; 26: 228-236
  CrossrefPubMedGoogle Scholar
• 4 Bharathi MJ, Ramakrishnan R, Meenakshi R et al. Analysis of the risk factors predisposing to fungal, bacterial & Acanthamoeba keratitis in south India. Indian J Med Res 2009; 130: 749-757
  PubMedGoogle Scholar
• 5 Stapleton F, Edwards K, Keay L et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology 2012; 119: 1516-1521
  CrossrefPubMedGoogle Scholar
• 6 Stapleton F, Keay L, Edwards K et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology 2008; 115: 1655-1662
  CrossrefPubMedGoogle Scholar
• 7 Keay L, Edwards K, Naduvilath T et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006; 113: 109-116
  CrossrefPubMedGoogle Scholar
• 8 Yildiz EH, Airiani S, Hammersmith KM et al. Trends in contact lens-related corneal ulcers at a tertiary referral center. Cornea 2012; 31: 1097-1102
  CrossrefPubMedGoogle Scholar
• 9 Koffler BH, Sears JJ. Myopia control in children through refractive therapy gas permeable contact lenses: is it for real?. Am J Ophthalmol 2013; 156: 1076-1081
  CrossrefPubMedGoogle Scholar
• 10 Swarbrick HA, Alharbi A, Watt K et al. Myopia control during orthokeratology lens wear in children using a novel study design. Ophthalmology 2015; 122: 620-630
  CrossrefPubMedGoogle Scholar
• 11 Morgan PB, Efron N, Hill EA et al. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol 2005; 89: 430-436
  CrossrefPubMedGoogle Scholar
• 12 Wilhelmus KR, Schlech BA. Clinical and epidemiological advantages of culturing bacterial keratitis. Cornea 2004; 23: 38-42
  CrossrefPubMedGoogle Scholar
• 13 Böhm MR, Prokosch V, Merté RL et al. Mikrobiologische Analyse in Kontaktlinsen-assoziierte Keratits. Klin Monatsbl Augenheilkd 2011; 228: 808-814
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Saeed A, DʼArcy F, Stack J et al. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland. Cornea 2009; 28: 285-292
  CrossrefPubMedGoogle Scholar
• 15 Willcox MD. Microbial adhesion to silicone hydrogel lenses: a review. Eye Contact Lens 2013; 39: 61-66
  PubMedGoogle Scholar
• 16 Cheng KH, Leung SL, Hoekman HW et al. Incidence of contact-lens-associated microbial keratitis and its related morbidity. Lancet 1999; 354: 181-185
  CrossrefPubMedGoogle Scholar
• 17 Schein OD, Buehler PO, Stamler JF et al. The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis. Arch Ophthalmol 1994; 112: 186-190
  CrossrefPubMedGoogle Scholar
• 18 Donnenfeld ED, Kim T, Holland EJ et al. ASCRS White Paper: Management of infectious keratitis following laser in situ keratomileusis. J Cataract Refract Surg 2005; 31: 2008-2011
  CrossrefPubMedGoogle Scholar
• 19 Garg P, Chaurasia S, Vaddavalli PK et al. Microbial keratitis after LASIK. J Refract Surg 2010; 26: 209-216
  CrossrefPubMedGoogle Scholar
• 20 Karp CL, Tuli SS, Yoo SH et al. Infectious keratitis after LASIK. Ophthalmology 2003; 110: 503-510
  CrossrefPubMedGoogle Scholar
• 21 Chang MA, Jain S, Azar DT. Infections following laser in situ keratomileusis: an integration of the published literature. Surv Ophthalmol 2004; 49: 269-280
  CrossrefPubMedGoogle Scholar
• 22 Wroblewski KJ, Pasternak JF, Bower KS et al. Infectious keratitis after photorefractive keratectomy in the United States army and navy. Ophthalmology 2006; 113: 520-525
  CrossrefPubMedGoogle Scholar
• 23 Bourcier T, Thomas F, Borderie V et al. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol 2003; 87: 834-838
  CrossrefPubMedGoogle Scholar
• 24 Wong VW, Lai TY, Chi SC et al. Pediatric ocular surface infections: a 5-year review of demographics, clinical features, risk factors, microbiological results, and treatment. Cornea 2011; 30: 995-1002
  CrossrefPubMedGoogle Scholar
• 25 Malik A, Claoué C. Transport and interaction of cosmetic product material within the ocular surface: beauty and the beastly symptoms of toxic tears. Cont Lens Anterior Eye 2012; 35: 247-259
  CrossrefPubMedGoogle Scholar
• 26 Pate JC, Jones DB, Wilhelmus KR. Prevalence and spectrum of bacterial co-infection during fungal keratitis. Br J Ophthalmol 2006; 90: 289-292
  CrossrefPubMedGoogle Scholar
• 27 Mondino BJ, Pleyer U. Host defence against bacterial and fungal disease. In: Tasman W, Jaeger EA, , eds. Duaneʼs Biomedical Foundations of Ophthalmology, Vol. 4, Chapter 12. New York: Lippincott; 1998
  Google Scholar
• 28 Pleyer U, Behrens-Baumann W. Bakterielle Keratitis. Aktuelle Aspekte zur Diagnostik. Ophthalmologe 2007; 104: 9-14
  CrossrefPubMedGoogle Scholar
• 29 Dalmon C, Porco TC, Lietman TM et al. The clinical differentiation of bacterial and fungal keratitis: a photographic survey. Invest Ophthalmol Vis Sci 2012; 53: 1787-1791
  CrossrefPubMedGoogle Scholar
• 30 BenEzra D. Ocular surface inflammation: guidelines for diagnosis and treatment. Panama: Highlights of Ophthalmology; 2003: 59-64
  Google Scholar
• 31 Deutsche Ophthalmologische Gesellschaft. Leitlinie Nr. 13: Keratitis.. Im Internet: http://www.dog.org/wp-content/uploads/2009/09/Leitlinie-Nr.-13-Keratitis.pdf Stand: 22.02.2015
  PubMedGoogle Scholar
• 32 Pakzad-Vaezi K, Levasseur SD, Schendel S et al. The corneal ulcer one-touch study: a simplified microbiological specimen collection method. Am J Ophthalmol 2015; 159: 37-43
  CrossrefPubMedGoogle Scholar
• 33 Bhadange Y, Sharma S, Das S et al. Role of liquid culture media in the laboratory diagnosis of microbial keratitis. Am J Ophthalmol 2013; 156: 745-751
  CrossrefPubMedGoogle Scholar
• 34 Marangon FB, Miller D, Alfonso EC. Impact of prior therapy on the recovery and frequency of corneal pathogens. Cornea 2004; 23: 158-164
  CrossrefPubMedGoogle Scholar
• 35 Lohmann CP, Winkler von Mohrenfels C, Gabler B et al. Die Polymerase-Kettenreaktion (PCR) zur mikrobiologischen Diagnostik einer persistierenden infektiösen Keratitis: Eine klinische Studie bei 16 Patienten. Klin Monatsbl Augenheilkd 2000; 217: 37-42
  Article in Thieme ConnectPubMedGoogle Scholar
• 36 Panda A, Pal Singh T, Satpathy G et al. Comparison of polymerase chain reaction and standard microbiological techniques in presumed bacterial corneal ulcers. Int Ophthalmol 2015; 35: 159-165
  CrossrefPubMedGoogle Scholar
• 37 Tokman HB, İskeleli G, Dalar ZG et al. Prevalence and antimicrobial susceptibilities of anaerobic bacteria isolated from perforated corneal ulcers by culture and multiplex PCR: an evaluation in cases with keratitis and endophthalmitis. Clin Lab 2014; 60: 1879-1886
  PubMedGoogle Scholar
• 38 Goldschmidt P, Rostane H, Saint-Jean C et al. Effects of topical anesthetics and fluorescein on the real-time PCR used for the diagnosis of Herpesviruses and Acanthamoebal keratitis. Br J Ophthalmol 2006; 90: 1354-1356
  CrossrefPubMedGoogle Scholar
• 39 Orlans HO, Hornby SJ, Bowler IC. In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye (Lond) 2011; 25: 489-493
  CrossrefPubMedGoogle Scholar
• 40 Benson H. Permeability of the cornea to topically applied drugs. Arch Ophthalmol 1974; 91: 313-327
  CrossrefPubMedGoogle Scholar
• 41 Hariprasad SM, Shah GK, Mieler WF et al. Vitreous and aqueous penetration of orally administered Moxifloxacin in humans. Arch Ophthalmol 2006; 124: 178-182
  CrossrefPubMedGoogle Scholar
• 42 Souza JG, Dias K, Pereira TA et al. Topical delivery of ocular therapeutics: carrier systems and physical methods. J Pharm Pharmacol 2014; 66: 507-530
  CrossrefPubMedGoogle Scholar
• 43 McDonald EM, Ram FS, Patel DV et al. Topical antibiotics for the management of bacterial keratitis: an evidence-based review of high quality randomised controlled trials. Br J Ophthalmol 2014; 98: 1470-1477
  CrossrefPubMedGoogle Scholar
• 44 Kowalski RP, Kowalski TA, Shanks RM et al. In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection. Cornea 2013; 32: 830-834
  CrossrefPubMedGoogle Scholar
• 45 Oldenburg CE, Lalitha P, Srinivasan M et al. Moxifloxacin susceptibility mediates the relationship between causative organism and clinical outcome in bacterial keratitis. Invest Ophthalmol Vis Sci 2013; 54: 1522-1526
  CrossrefPubMedGoogle Scholar
• 46 Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev 2014; (10) CD005430
  PubMedGoogle Scholar
• 47 Srinivasan M, Mascarenhas J, Rajaraman R et al. Steroids for Corneal Ulcers Trial Group. The steroids for corneal ulcers trial: study design and baseline characteristics. Arch Ophthalmol 2012; 130: 151-157
  CrossrefPubMedGoogle Scholar
• 48 Srinivasan M, Mascarenhas J, Rajaraman R et al. Visual recovery in treated bacterial keratitis. Ophthalmology 2014; 121: 1310-1311
  CrossrefPubMedGoogle Scholar
• 49 Cursiefen C, Viaud E, Bock F et al. Aganirsen antisense oligonucleotide eye drops inhibit keratitis-induced corneal neovascularization and reduce need for transplantation: the I-CAN study. Ophthalmology 2014; 121: 1683-1692
  CrossrefPubMedGoogle Scholar
• 50 Wilhelmus KR, Schlech BA. Clinical and epidemiological advantages of culturing bacterial keratitis. Cornea 2004; 23: 38-42
  CrossrefPubMedGoogle Scholar
• 51 Morlet N, Minassian D, Butcher J. Risk factors for treatment outcome of suspected microbial keratitis. Ofloxacin Study Group. Br J Ophthalmol 1999; 83: 1027-1031
  CrossrefPubMedGoogle Scholar
• 52 Stübiger N, Pleyer U, Erb C et al. Keratoplastik á chaud. Ophthalmologe 1995; 92: 427-432
  PubMedGoogle Scholar
• 53 Prajna NV, Srinivasan M, Lalitha P et al. Differences in clinical outcomes in keratitis due to fungus and bacteria. JAMA Ophthalmol 2013; 131: 1088-1089
  CrossrefPubMedGoogle Scholar