Nosocomial Corneal Ulcers in a Tertiary Hospital Setting

1
Nosocomial Corneal Ulcers in a Tertiary Hospital
Setting

• Faris R. Ghosheh
• Ramzi K. Hemady

2
Objective

• Identify risk factors
• Optimize treatment

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Methods

• 2 year study
• Inclusion Criteria
• 18 years and older
• Develop corneal ulcer during hospitalization

4
Methods

• Data collected

5
Results-Demographics

• 10 patients (12 eyes total) in past 30 months
• Patient Characteristics
• Age 19-73 (Avg 34)
• 5 male/5 female
• Reason for admission
• 7 MVC, 1 Orbital cellulitis, 2 GSW
• Day of ophthalmology consult 1-30
• Average HD8

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Results-Demographics

• All patients with central lines, Urinary
  catheters
• Ventilators 8/10
• 7/10 patients with systemic infection

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Results-Exam

• Average Ulcer size 29.50 mm2
• Epithelial defect 10/12
• Exposure 8/12
• Discharge 6/12
• 7th nerve palsy 3/12

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Results - Microbiology

• Culture results 9/12 positive
• 3 Pseudomonas
• 2 Coag negative staph
• 1 Serratia
• 1 MRSA and 1 MSSA
• 1 Klebsiella
• Sensitivities
• 2 Pseudomonas resistant to Gatifloxacin
• 3/4 Staphylococcal species resistant to Ancef

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Results Medical intervention

• Fortified antibiotic regimen
• Cefazolin or Vancomycin started in 12/12 eyes
• Tobramycin or Gentamicin started in 9/12 eyes
• Ciprofloxacin or Moxifloxacin started in 11/12
  eyes

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Results-Surgical intervention

• One perforation treated with lamellar
  keratoplasty
• 6/12 eyes with tarsorraphy
• Corneal ulcer resolved in 9/12 eyes

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Results-Final Outcome

• Scarring occurred in 9/12 eyes
• Final visual acuity ranged from 20/70 to LP

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Conclusion

• Nosocomial ulcers are severe and resistant
  bacteria can make treatment difficult
• Even with early ophthalmologic intervention,
  ulcers develop and become severely debilitating
• Intubation coupled with corneal exposure places
  patients at higher risk for corneal infections
• Nosocomial bacteria are highly resistant to
  standard fortified antibiotic regimens
• Consider starting Vancomycin
• Monitor for emerging resistance to
  fluoroquinolones