Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Peripheral and Central Bacterial Keratitis in South Korea for Ten Years

Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Peripheral and Central Bacterial Keratitis in South Korea for Ten Years | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Peripheral and Central Bacterial Keratitis in South Korea for Ten Years Donghyun Jee, Su Yeon Han, Hyun Seung Kim, Eun Chul Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4695589/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To evaluate the bacterial spectrum and antimicrobial susceptibility pattern of bacterial keratitis in South Korea for ten years. Methods: 143 eyes of 143 patients who have been diagnosed with bacterial keratitis from January 2010 to April 2019 were retrospectively enrolled. Corneal scraping was done for Gram stain in all patients, and cultures were plated on blood, chocolate, Sabouraud dextrose agar, and thioglycolate broth. Empirical fourth generation fluoroquinolone or fortified vancomycin and ceftazidime were treated for every patient. Results: Ocular trauma (n=29, 24.0%) and contact lens (n=18, 14.9%) were the most common causes in patients with bacterial keratitis. Most of the bacterial keratitis was gram-positive (n=85, 70%) and the gram-negative is only 6% (7 eyes). Most of central and peripheral keratitis were Gram positive (n=57, 65% and n=29, 85%). There was no gram-negative stain in peripheral keratitis. Vancomycin and ciprofloxacin were the most susceptible (n=68, 56.2% and n=51, 42.1%) and least resistant (n=0, 0% and n=18, 14.9%) in the antibiotic susceptibility test. Treatment time (month) and best corrected visual acuity after treatment in the gatifloxacin group were better than those in the moxifloxacin group (P<0.05). Conclusion: The most common cause of bacterial keratitis was ocular trauma and contact lenses. There was a different bacterial spectrum in central and peripheral keratitis. Gatifloxacin was more effective for early corneal healing and recovery of visual acuity than moxifloxacin. bacterial keratitis bacterial spectrum antimicrobial susceptibility central keratitis peripheral keratitis Figures Figure 1 Figure 2 Introduction The most common cause of microbial keratitis is bacterial keratitis.[ 1 , 2 ] Bacterial keratitis is one of the most common causes of vision impairment in working-age individuals.[ 3 ] Gram-positive bacteria are most commonly associated with infections after ocular surgery or disease, and less commonly associated with keratitis after ocular trauma or contact lens wear, where environmental organisms predominate, particularly Pseudomonas aeruginosa in contact lens-related disease.[ 4 ] The most common gram-positive pathogen recovered is coagulase-negative staphylococcus , with either Staphylococcus aureus or Streptococcus pneumoniae as the most common single isolate and Pseudomonas aeruginosa , the most common gram-negative pathogen.[ 4 ] Less common organisms reported in Asia include non-tuberculous mycobacteria and Microsporidia spp .[ 5 ] In the initial treatment of bacterial keratitis, the usage of commercially available fourth-generation fluoroquinolones versus compounded fortified antibiotics such as vancomycin and tobramycin has been debated.[ 6 , 7 ] According to the AAO 2018 study on bacterial keratitis, fluoroquinolone monotherapy is at least as effective as combination therapy with fortified drops.[ 8 ] On the other hand, fluoroquinolone resistance was very common among bacteria from ocular infections in central India, although there has been a recent decline in resistance to several fluoroquinolones.[ 9 ] But, for all gram-positive bacteria examined, the minimum inhibitory concentrations (MICs) for fourth-generation fluoroquinolones were significantly lower than those for second-generation fluoroquinolones.[ 10 ] When the two fourth-generation fluoroquinolones were compared, moxifloxacin had lower MICs for most gram-positive bacteria and gatifloxacin had lower MICs for most gram-negative bacteria.[ 10 , 11 ] And gatifloxacin 0.3% or moxifloxacin 0.5% were safe enough not to result in severe epithelial damage in healthy human corneas.[ 12 ] There were a lot of reports about the pathogens and antibiotic susceptibilities of bacterial keratitis.[ 13 – 17 ] However, there was no report about the comparison of the bacterial spectrum and antimicrobial susceptibility pattern in the peripheral and central keratitis. Thus, the objective of this study was to evaluate the bacterial spectrum and antimicrobial susceptibility pattern of peripheral and central bacterial keratitis in South Korea for ten years. And we also evaluated the efficacy of empirical treatment with gatifloxacin and moxifloxacin in bacterial keratitis. Methods We performed a retrospective chart review and data analysis in this study.. This study was carried out in accordance with Institutional Review Board standards and the Helsinki Declaration. This study protocol was approved by Bucheon St. Mary Hospital's Institutional Review Board (IRB)/Ethics Committee. Patients’ examination 143 eyes of 143 patients who have been diagnosed with bacterial keratitis from January 2010 to April 2019 were enrolled. Corneal scraping using Kimura spatulas was performed for Gram stain in all patients, and cultures were performed on blood, chocolate, Sabouraud dextrose agar, and thioglycolate broth. Empirical fourth-generation fluoroquinolone or fortified vancomycin and ceftazidime were treated for every patient. The patients were divided into two groups: group 1 (central keratitis, 87 eyes) and group 2 (peripheral keratitis, 34 eyes). And the patients were divided into four groups according to initial treatment; group 1 (gatifloxacin 0.3%, 70 eyes), group 2 (moxifloxacin 0.5%, 40 eyes), group 3 (ciprofloxacin 1.5%, 2 eyes), and group 4 (fortified vancomycin 2.5% and ceftazidime 5%, 8 eyes). The clinical data were collected from each medical record: age, gender, previous history of ocular morbidity, contact lens use, and history of ocular surgery or trauma. Their clinical data were recorded after a complete ophthalmological examination. Causative organisms, antibiotic susceptibility test, mean treatment time (month), and best corrected visual acuity (BCVA) were examined before and after treatment. An automated Vitek 2 system (bioMe'rieux, Inc., Marcy l'Etoile, France) was used for antimicrobial identification and susceptibility testing. Isolates were classified as sensitive, intermediate, or resistant to the antibiotics examined. Vancomycin, cefazolin, cefuroxime, chloramphenicol, oxacillin, penicillin, ciprofloxacin, levofloxacin, moxifloxacin, carbapenem (meropenem and imipenem), tobramycin, ceftazidime, amikacin, and gentamicin were among the antibiotics studied. The isolated bacteria were classified into four types for analysis: gram-positive cocci, gram-positive bacilli, gram-negative cocci, and gram-negative bacilli. Statistical Analysis All statistical analyses were performed using a commercial program (SPSS for Windows, version 21.0.1; SPSS Inc., Chicago, IL). The Wilcoxon signed rank test was used to compare the data before and after treatment. Comparisons among all groups were performed with one-way analysis of variance (ANOVA) with Bonferroni post hoc comparison. If the variances were not homogeneous, the Tamhane test was used for the post hoc comparison between pairs of groups. The chi-square test was used for the comparison among groups of different proportions. P values < 0.05 were considered statistically significant. P values < 0.05 were considered statistically significant. Results Table 1 represents the characteristics of patients in each group. BCVA after treatment (0.23 ± 0.12 logMAR) was better than BCVA before treatment (0.36 ± 0.15) in patients with bacterial keratitis (p < 0.05). Table 1 Data of patients Parameter Number of patients 30 F:M 48:73 Age, years (range) 51.9 ± 22.1 BCVA before treatment (logMAR) 0.36 ± 0.15 BCVA after treatment (logMAR) *0.23 ± 0.12 BCVA after treatment was better than BCVA before treatment in patients with bacterial keratitis (p < 0.05). BCVA: best corrected visual acuity logMAR : Logarithm of the Minimum Angle of Resolution Values are presented as mean ± SD. *: P < 0.05 Causes of bacterial keratitis Ocular trauma (n = 29, 24.0%) and contact lenses (n = 18, 14.9%) were the most common causes in patients with bacterial keratitis. The other known causes of bacterial keratitis were ocular disease (uveitis, recurrent corneal erosion, and entropion), ocular surgery (cataract and keratoplasty), exposure keratopathy, and herpes keratitis (Table 2 ). Table 2 Causes of bacterial keratitis. Diagnosis Eyes Trauma 29 Contact lenses 18 Ocular disease (uveitis, RCE, entropion) 8 Ocular surgery (Cataract, KP) 8 Exposure keratopathy 5 Herpes keratitis 4 Unknown 49 Total 121 Ocular trauma and contact lenses were the most common causes in patients with bacterial keratitis. RCE: recurrent corneal erosion KP: keratoplasty Gram Stain Most of the bacterial keratitis was gram-positive (n = 85, 70%), and gram-negative was only 6% (7 eyes). 24% (29 eyes) were not detected with gram stain (Fig. 1 A). Most of the results of culture were gram-positive cocci (GPC) (n = 63, 52%) and gram-negative bacilli (GNB) (n = 21, 17%). Gram-positive bacilli (GPB) (n = 6, 5%) and mixed infection with GPC and GNB (n = 5, 4%) were also detected. 22% (26 eye) was not detected with culture (Fig. 1 B). Bacterial keratitis consisted of central keratitis (87 eyes, 72.0%) and peripheral keratitis (34 eyes, 38.0%). Most of the central bacterial keratitis was Gram positive (n = 57, 65%) and the Gram negative is only 8% (7 eyes). 24% (27 eyes) was not detected with Gram stain (Fig. 2 A). Most of the peripheral bacterial keratitis was Gram positive (n = 29, 85%) and the Gram negative is none. 15% (5 eyes) was not detected with Gram stain (Fig. 2 B). Causative organisms of bacterial keratitis Staphylococcus epidermidis (n = 43, 35.5%) was the most common causative organism in patients with central and peripheral bacterial keratitis. Moraxella, Pseudomonas aeruginosa, Staphylococcus aureus, Propionibacterium acnes, Staphylococcus hominis , and mixed organisms were detected only in central keratitis. Enterobacter and Staphylococcus caprae were detected only in peripheral keratitis (Table 3 ). Table 3 Causative organisms of bacterial keratitis. Causative organism Central Peripheral Total Staphylococcus epidermidis 22 21 43 Serratia marcescens 2 2 4 Moraxella 4 0 4 Pseudomonas aeruginosa 3 0 3 Staphylococcus capitis 3 2 5 Staphylococcus aureus 3 0 3 Enterobacter 0 2 2 Staphylococcus caprae 0 2 2 Propionibacterium acnes 2 0 2 Staphylococcus hominis 2 0 2 Mixed organisms 5 0 5 Other organism 14 6 20 No growth 21 5 26 Total 87 34 121 Staphylococcus epidermidis was the most common causative organism in patients with central and peripheral bacterial keratitis. RCE: recurrent corneal erosion KP: keratoplasty Antibiotics susceptibility of bacterial keratitis Vancomycin was the most susceptible (n = 68, 56.2%) and least resistant (n = 0, 0%) antibiotic and ciprofloxacin was second most susceptible (n = 51, 42.1%) and second least resistant (n = 18, 14.9%) antibiotic in patients with bacterial keratitis. There were no results in every antibiotic susceptibility test from 46 (38.0%) to 57 (47.1%) patients (Table 4 ). Table 4 Antibiotics susceptibility of bacterial keratitis. Inhibitory Resistant Susceptible No result Total Ciprofloxacin 6 18 51 46 121 Erythromycin 3 31 33 54 121 Gentamycin 9 17 38 57 121 Penicilline 1 52 15 53 121 Tetracycline 0 22 46 53 121 Vancomycin 0 0 68 53 121 Vancomycin was the most susceptible and least resistant antibiotic and ciprofloxacin was second most susceptible and the second least resistant antibiotic in patients with bacterial keratitis. Comparison of the effectiveness of antibiotics Duration of treatment and BCVA after treatment (1.73 ± 0.74 months and 0.21 ± 0.10 logMAR) in the gatifloxacin group were significantly better than those (2.51 ± 0.95 and 0.30 ± 0.13) in the moxifloxacin group (P < 0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group (n = 30, 42.9%) was higher than that in the moxifloxacin group (n = 15, 37.5%). And the percentage of duration of treatment greater than 3 months in the gatifloxacin group (n = 13, 18.5%) was less than that in the moxifloxacin group (n = 9, 22.5%). The other groups were not incomparable with in the gatifloxacin and moxifloxacin groups because of the small number of cases. But the duration of treatment with vancomycin and ceftazidime ranged from 1 month to 3 months because of the initial severe condition of bacterial keratitis. Discussion Bacterial keratitis is a serious ophthalmic emergency that is one of the leading causes of corneal blindness and visual loss.[ 18 , 19 ] Early diagnosis and treatment of appropriate antimicrobial medication is very important to prevent its fatal complications.[ 20 ] Bacterial keratitis is far more common in developing nations, where access to hospital facilities is limited and hazardous jobs such as farming and agriculture are more common.[ 21 ] Zhang Z et al. reported that the overall positive culture rate was 47% (95% confidence interval, 42–52%). In a meta-analysis of bacterial keratitis, gram-positive cocci were the most common (62%), followed by gram-negative bacilli (30%), gram-positive bacilli (5%), and gram-negative cocci (5%).[ 14 ] In our report, the overall positive gram stain rate was 76% and the positive culture rate was 78%. The culture rate of bacterial keratitis in our study was much higher than in other reports. Most of the bacterial keratitis was gram-positive (n = 85, 70%) and the gram-negative is only 6% (7 eyes) (Fig. 1 A). Most of the results of culture were gram-positive cocci (GPC) (n = 63, 52%) and gram-negative bacilli (GNB) (n = 21, 17%). Gram positive bacilli (GPB) (n = 6, 5%) and mixed infection with GPC and GNB (n = 5, 4%) were also detected (Fig. 1 B). The bacterial strains of the culture in our study were similar to those in earlier reports. The bacteriological profile and causation of bacterial keratitis differ based on geographic region, referral patterns, and other factors.[ 22 ] But Staphylococcus epidermidis, Staphylococcus aureus , other coagulase-negative Staphylococcus species, Streptococcus pneumonia , and Pseudomonas aeruginosa were describeded to be the most prevalent organisms in bacterial keratitis.[ 22 ] But Palmer GS. Et al. reported that Pseudomonas was the most common bacterial cause of infected keratitis, followed by Staphylococcus and Bacillus .[ 15 ] In our study, Staphylococcus epidermidis (n = 43, 35.5%) was also the most common causative organism in patients with central and peripheral bacterial keratitis. The characteristics of central keratitis were reported to be larger ulcerations (> 4 mm 2 ) with inflammation and more often positive culture results.[ 23 ] In our study, bacterial keratitis consisted of central keratitis (87 eyes, 72.0%) and peripheral keratitis (34 eyes, 38.0%). The central keratitis and peripheral keratitis had different gram stain pattern. Most of the central bacterial keratitis was gram-positive (n = 57, 65%) and the gram-negative was only 8% (7 eyes) (Fig. 2 A). Most of the peripheral bacterial keratitis was Gram positive (n = 29, 85%) and the Gram negative was none (Fig. 2 A). The central keratitis and peripheral keratitis also had different pathogen patterns. Moraxella, Pseudomonas aeruginosa, Staphylococcus aureus, Propionibacterium acnes, Staphylococcus hominis , and mixed organisms were detected only in central keratitis. Enterobacter and Staphylococcus caprae were detected only in peripheral keratitis (Table 3 ). Predisposing factors for bacterial keratitis were reported to be ocular surface disease (26/57 = 45.6%), contact lens wear (26/57 = 45.6%),[ 24 ] and previous trauma (5/57 = 8.8%).[ 23 ] On the other hand, the most common cause of bacterial keratitis was ocular trauma (n = 29, 24.0%), followed by contact lenses (n = 18, 14.9%), ocular disease (n = 8, 6.6%), and ocular surgery (n = 8, 6.6%) in our result. The unknown causes were the most common in our study (n = 49, 40.5%) (Table 2 ) Austin A. et al. reported that the initial treatment of bacterial keratitis differs from clinicians in the USA being more likely to use fortified antibiotics versus fluoroquinolone monotherapy.[ 6 ] Fluoroquinolones prescribed as an empiric first-line treatment of bacterial keratitis are at least as effective as fortified antibiotics.[ 7 ] But, resistance to fluoroquinolones was common among bacterial keratitis.[ 9 ] And S. epidermidis strains isolated from three ocular pathologies were resistant to gatifloxacin and moxifloxacin due to mutations on the gyrA and parC genes.[ 1 ] Therefore, we usually use fluoroquinolone as an empirical therapy in common bacterial keratitis, but fortified antibiotics such as vancomycin and ceftazidime were used in severe corneal infiltration[ 25 ] in the initial examination. Vancomycin was the most susceptible and least resistant antibiotic and ciprofloxacin was second most susceptible and the second least resistant antibiotic in patients with bacterial keratitis (Table 4 ). There was no treatment failure in both of the empirical therapies with fluoroquinolone or fortified antibiotics in our study (Table 5 ) Table 5 Comparison of effectiveness of antibiotics Gatifloxacin Moxifloxacin Ciprofloxacin Vancomycin ceftazidime Eyes 70 40 2 8 Substitution to fortified antibiotics 1 4 2 0 Treatment time (Month) *1.73 ± 0.74 2.51 ± 0.95 1.50 ± 0.85 2.00 ± 0.75 Treatment less than 1 Month (eyes, %) 30 (42.9%) 15 (37.5%) 1 0 Treatment more than 3 Months (eyes, %) 13 (18.6%) 9 (22.5%) 0 0 BCVA before treatment (logMAR) 0.35 ± 0.12 0.33 ± 0.14 0.32 ± 0.20 0.35 ± 0.16 BCVA after treatment (logMAR) *0.21 ± 0.10 0.30 ± 0.13 0.30 ± 0.15 0.31 ± 0.17 Treatment Failure 0 0 0 0 BCVA: best corrected visual acuity logMAR : Logarithm of the Minimum Angle of Resolution Duration of treatment and BCVA after treatment in the gatifloxacin group were significantly better than those in the moxifloxacin group (P < 0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group was higher than that in the moxifloxacin group. And the percentage of duration of treatment greater than 3 months in the gatifloxacin group was less than that in the moxifloxacin group. Values are presented as mean ± SD. *: P < 0.05 There was a decrease in resistance to some of the fluoroquinolones.[ 9 ] The fourth-generation fluoroquinolones (gatifloxacin and moxifloxacin) were found to be more effective against Staphylococcus aureus isolates resistant to ciprofloxacin, ofloxacin, and levofloxacin.[ 10 ] Moxifloxacin and gatifloxacin were the most effective against MRSA bacteria in both planktonic and biofilm forms.[ 11 ] And gatifloxacin 0.3% or moxifloxacin 0.5% was very safe and had no epithelial damage in normal human corneas after instillation.[ 12 ] Gatifloxacin had a different antibacterial susceptibility compared with moxifloxacin. Moxifloxacin had lower MICs for the majority of gram-positive bacteria, whereas gatifloxacin had lower MICs for the majority of gram-negative bacteria.[ 10 ] In our study, duration of treatment and BCVA after treatment (1.73 ± 0.74 months and 0.21 ± 0.10 logMAR) in the gatifloxacin group were significantly better than those (2.51 ± 0.95 and 0.30 ± 0.13) in the moxifloxacin group (P < 0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group (n = 30, 42.9%) was higher than that in the moxifloxacin group (n = 15, 37.5%). And the percentage of duration of treatment greater than 3 months in the gatifloxacin group (n = 13, 18.5%) was less than that in the moxifloxacin group (n = 9, 22.5%) (Table 5 ). A limitation of our investigation was that a multicenter clinical trial with a bigger sample size and a longer follow-up period was required to observe the bacterial spectrum and antimicrobial susceptibility pattern of peripheral and central bacterial keratitis. In conclusion, there was a different bacterial spectrum in central and peripheral keratitis. The most common cause of bacterial keratitis was ocular trauma (n = 29, 24.0%), followed by contact lens (n = 18, 14.9%). Both of fortified antibiotics and fluoroquinolone were effective for empirical therapy. Gatifloxacin was more effective for early corneal healing and recovery of visual acuity than moxifloxacin. Abbreviations GPC: gram-positive cocci, GNB : gram-negative bacilli, GPB: gram-positive bacilli (GPB) Declarations Acknowledgements None. Authors’ contributions DJ was involved in analysis and interpretation of data and drafting the manuscript. DJ, SYH, HSK, ECK made contribution to acquisition of data and drafting. ECK contributed to conception and design, analysis and interpretation of data, drafting and revising the manuscript. All authors read and approved the final manuscript. Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government(MSIT) (No. 2022R1F1A1069218) and grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health and Welfare, Republic of Korea (No. HC23C0130). Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was approved by the institutional review board at Bucheon St. Mary’s Hospital (HC22RASI0099); the informed consent was waived. All clinical investigations have been conducted according to the principles expressed in the Declaration of Helsinki. Consent for publication Not applicable. 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Oldenburg CE, Lalitha P, Srinivasan M, Manikandan P, Bharathi MJ, Rajaraman R, Ravindran M, Mascarenhas J, Nardone N, Ray KJ et al : Moxifloxacin susceptibility mediates the relationship between causative organism and clinical outcome in bacterial keratitis . Invest Ophthalmol Vis Sci 2013, 54 (2):1522-1526. Shah A, Sachdev A, Coggon D, Hossain P: Geographic variations in microbial keratitis: an analysis of the peer-reviewed literature . Br J Ophthalmol 2011, 95 (6):762-767. Bennett HG, Hay J, Kirkness CM, Seal DV, Devonshire P: Antimicrobial management of presumed microbial keratitis: guidelines for treatment of central and peripheral ulcers . Br J Ophthalmol 1998, 82 (2):137-145. Yang YS, Chun JW, Koh JW: Keratitis with Elizabethkingia meningoseptica Occurring after Contact Lens Wear: A Case Report . Korean J Ophthalmol 2013, 27 (2):133-136. Song YY, Ahn M, Cho NC, You IC: A Case of Rothia mucilaginosa Keratitis in South Korea . Korean J Ophthalmol 2017, 31 (5):460-461. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4695589","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335737411,"identity":"7495ea03-fc4e-45bb-b09c-f281c38639ae","order_by":0,"name":"Donghyun Jee","email":"","orcid":"","institution":"The Catholic University of Korea College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Donghyun","middleName":"","lastName":"Jee","suffix":""},{"id":335737412,"identity":"e4e0513d-0b38-4d35-b5f0-eaceb1bff9d6","order_by":1,"name":"Su Yeon Han","email":"","orcid":"","institution":"The Catholic University of Korea College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Su","middleName":"Yeon","lastName":"Han","suffix":""},{"id":335737413,"identity":"ffc173e0-05d0-44a8-bc5c-25514a309fc7","order_by":2,"name":"Hyun Seung Kim","email":"","orcid":"","institution":"The Catholic University of Korea College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hyun","middleName":"Seung","lastName":"Kim","suffix":""},{"id":335737414,"identity":"7a5d2154-6d45-45ff-bc1e-29efe649788a","order_by":3,"name":"Eun Chul Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYJACZgYGCzkDMNPAgmgtEsZQLRIQPjFaEjdA2ERo4ZfIPfi5oEIifTv72aMbfhRIMJiz9x/Aq0VyRl6y9IwzErk7e/LSbvYAHWbZcxi/LQY3csyYedskcjccyDG7wQPUYnAjGb8We6iWdIPzb8xu/gFpuf+YgC0SEC0JIOtuQ2wh4H2JM2+MpXnOSBhuuPHG7LaMgQSPwZlkA7xa+NtzDD/zVNjIG5zPMbv55o+NnMHxgw/wW4MOeEhTPgpGwSgYBaMAKwAA/HI/AvqizhwAAAAASUVORK5CYII=","orcid":"","institution":"The Catholic University of Korea College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Eun","middleName":"Chul","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2024-07-06 07:42:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4695589/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4695589/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62187349,"identity":"de29c182-b23a-4040-99b7-d785c6e3c553","added_by":"auto","created_at":"2024-08-10 12:10:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105704,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe results of gram stain (A) and culture (B) in patients with bacterial keratitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the bacterial keratitis was gram-positive (n=85, 70%) and gram-negative is only 6% (7 eyes). 24% (29 eyes) were not detected with gram stain (A). Most of the results of culture were gram-positive cocci (GPC) (n=63, 52%) and gram-negative bacilli (GNB) (n=21, 17%). Gram-positive bacilli (GPB) (n=6, 5%) and mixed infection with GPC and GNB (n=5, 4%) were also detected. 22% (26 eyes) were not detected with culture (B).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4695589/v1/c8dac2b44a94240f6b53cd3f.jpg"},{"id":62187350,"identity":"0f6cae9f-6508-4973-bdfc-63c68a1cd237","added_by":"auto","created_at":"2024-08-10 12:10:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104098,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe results of Gram stain in central (A) and peripheral (B) keratitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost of the central bacterial keratitis was gram positive (n=57, 65%) and gram-negative was only 8% (7 eyes). 24% (27 eyes) were not detected with gram stain (A). Most of the peripheral bacterial keratitis was gram-positive (n=29, 85%) and gram-negative was none. 15% (5 eyes) was not detected with gram stain (B).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4695589/v1/d533ec55f9c73bc2ff066fe5.jpg"},{"id":63773615,"identity":"104fa79b-a19d-4d1a-b704-0f5fe1a90114","added_by":"auto","created_at":"2024-09-02 08:33:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1393963,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4695589/v1/99dcef96-306a-41fd-8e62-33f0aa9b9121.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Peripheral and Central Bacterial Keratitis in South Korea for Ten Years","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe most common cause of microbial keratitis is bacterial keratitis.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Bacterial keratitis is one of the most common causes of vision impairment in working-age individuals.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Gram-positive bacteria are most commonly associated with infections after ocular surgery or disease, and less commonly associated with keratitis after ocular trauma or contact lens wear, where environmental organisms predominate, particularly Pseudomonas aeruginosa in contact lens-related disease.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The most common gram-positive pathogen recovered is \u003cem\u003ecoagulase-negative staphylococcus\u003c/em\u003e, with either \u003cem\u003eStaphylococcus aureus\u003c/em\u003e or \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e as the most common single isolate and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, the most common gram-negative pathogen.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Less common organisms reported in Asia include \u003cem\u003enon-tuberculous mycobacteria\u003c/em\u003e and \u003cem\u003eMicrosporidia spp\u003c/em\u003e.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In the initial treatment of bacterial keratitis, the usage of commercially available fourth-generation fluoroquinolones versus compounded fortified antibiotics such as vancomycin and tobramycin has been debated.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] According to the AAO 2018 study on bacterial keratitis, fluoroquinolone monotherapy is at least as effective as combination therapy with fortified drops.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] On the other hand, fluoroquinolone resistance was very common among bacteria from ocular infections in central India, although there has been a recent decline in resistance to several fluoroquinolones.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] But, for all gram-positive bacteria examined, the minimum inhibitory concentrations (MICs) for fourth-generation fluoroquinolones were significantly lower than those for second-generation fluoroquinolones.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] When the two fourth-generation fluoroquinolones were compared, moxifloxacin had lower MICs for most gram-positive bacteria and gatifloxacin had lower MICs for most gram-negative bacteria.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] And gatifloxacin 0.3% or moxifloxacin 0.5% were safe enough not to result in severe epithelial damage in healthy human corneas.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] There were a lot of reports about the pathogens and antibiotic susceptibilities of bacterial keratitis.[\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, there was no report about the comparison of the bacterial spectrum and antimicrobial susceptibility pattern in the peripheral and central keratitis.\u003c/p\u003e \u003cp\u003eThus, the objective of this study was to evaluate the bacterial spectrum and antimicrobial susceptibility pattern of peripheral and central bacterial keratitis in South Korea for ten years. And we also evaluated the efficacy of empirical treatment with gatifloxacin and moxifloxacin in bacterial keratitis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We performed a retrospective chart review and data analysis in this study.. This study was carried out in accordance with Institutional Review Board standards and the Helsinki Declaration. This study protocol was approved by Bucheon St. Mary Hospital's Institutional Review Board (IRB)/Ethics Committee.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; examination\u003c/h2\u003e \u003cp\u003e143 eyes of 143 patients who have been diagnosed with bacterial keratitis from January 2010 to April 2019 were enrolled. Corneal scraping using Kimura spatulas was performed for Gram stain in all patients, and cultures were performed on blood, chocolate, Sabouraud dextrose agar, and thioglycolate broth. Empirical fourth-generation fluoroquinolone or fortified vancomycin and ceftazidime were treated for every patient.\u003c/p\u003e \u003cp\u003eThe patients were divided into two groups: group 1 (central keratitis, 87 eyes) and group 2 (peripheral keratitis, 34 eyes). And the patients were divided into four groups according to initial treatment; group 1 (gatifloxacin 0.3%, 70 eyes), group 2 (moxifloxacin 0.5%, 40 eyes), group 3 (ciprofloxacin 1.5%, 2 eyes), and group 4 (fortified vancomycin 2.5% and ceftazidime 5%, 8 eyes).\u003c/p\u003e \u003cp\u003eThe clinical data were collected from each medical record: age, gender, previous history of ocular morbidity, contact lens use, and history of ocular surgery or trauma.\u003c/p\u003e \u003cp\u003eTheir clinical data were recorded after a complete ophthalmological examination. Causative organisms, antibiotic susceptibility test, mean treatment time (month), and best corrected visual acuity (BCVA) were examined before and after treatment.\u003c/p\u003e \u003cp\u003eAn automated Vitek 2 system (bioMe'rieux, Inc., Marcy l'Etoile, France) was used for antimicrobial identification and susceptibility testing. Isolates were classified as sensitive, intermediate, or resistant to the antibiotics examined. Vancomycin, cefazolin, cefuroxime, chloramphenicol, oxacillin, penicillin, ciprofloxacin, levofloxacin, moxifloxacin, carbapenem (meropenem and imipenem), tobramycin, ceftazidime, amikacin, and gentamicin were among the antibiotics studied. The isolated bacteria were classified into four types for analysis: gram-positive cocci, gram-positive bacilli, gram-negative cocci, and gram-negative bacilli.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using a commercial program (SPSS for Windows, version 21.0.1; SPSS Inc., Chicago, IL). The Wilcoxon signed rank test was used to compare the data before and after treatment. Comparisons among all groups were performed with one-way analysis of variance (ANOVA) with Bonferroni post hoc comparison. If the variances were not homogeneous, the Tamhane test was used for the post hoc comparison between pairs of groups. The chi-square test was used for the comparison among groups of different proportions. P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e represents the characteristics of patients in each group. BCVA after treatment (0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 logMAR) was better than BCVA before treatment (0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15) in patients with bacterial keratitis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eData of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF:M\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48:73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA before treatment (logMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA after treatment (logMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBCVA after treatment was better than BCVA before treatment in patients with bacterial keratitis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBCVA: best corrected visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003elogMAR : Logarithm of the Minimum Angle of Resolution\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. *: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCauses of bacterial keratitis\u003c/h2\u003e \u003cp\u003eOcular trauma (n\u0026thinsp;=\u0026thinsp;29, 24.0%) and contact lenses (n\u0026thinsp;=\u0026thinsp;18, 14.9%) were the most common causes in patients with bacterial keratitis. The other known causes of bacterial keratitis were ocular disease (uveitis, recurrent corneal erosion, and entropion), ocular surgery (cataract and keratoplasty), exposure keratopathy, and herpes keratitis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCauses of bacterial keratitis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEyes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact lenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcular disease (uveitis, RCE, entropion)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcular surgery (Cataract, KP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExposure keratopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHerpes keratitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eOcular trauma and contact lenses were the most common causes in patients with bacterial keratitis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eRCE: recurrent corneal erosion\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eKP: keratoplasty\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eGram Stain\u003c/h2\u003e \u003cp\u003eMost of the bacterial keratitis was gram-positive (n\u0026thinsp;=\u0026thinsp;85, 70%), and gram-negative was only 6% (7 eyes). 24% (29 eyes) were not detected with gram stain (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Most of the results of culture were gram-positive cocci (GPC) (n\u0026thinsp;=\u0026thinsp;63, 52%) and gram-negative bacilli (GNB) (n\u0026thinsp;=\u0026thinsp;21, 17%). Gram-positive bacilli (GPB) (n\u0026thinsp;=\u0026thinsp;6, 5%) and mixed infection with GPC and GNB (n\u0026thinsp;=\u0026thinsp;5, 4%) were also detected. 22% (26 eye) was not detected with culture (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBacterial keratitis consisted of central keratitis (87 eyes, 72.0%) and peripheral keratitis (34 eyes, 38.0%). Most of the central bacterial keratitis was Gram positive (n\u0026thinsp;=\u0026thinsp;57, 65%) and the Gram negative is only 8% (7 eyes). 24% (27 eyes) was not detected with Gram stain (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Most of the peripheral bacterial keratitis was Gram positive (n\u0026thinsp;=\u0026thinsp;29, 85%) and the Gram negative is none. 15% (5 eyes) was not detected with Gram stain (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCausative organisms of bacterial keratitis\u003c/h2\u003e \u003cp\u003e \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;43, 35.5%) was the most common causative organism in patients with central and peripheral bacterial keratitis. \u003cem\u003eMoraxella, Pseudomonas aeruginosa, Staphylococcus aureus, Propionibacterium acnes, Staphylococcus hominis\u003c/em\u003e, and mixed organisms were detected only in central keratitis. \u003cem\u003eEnterobacter\u003c/em\u003e and \u003cem\u003eStaphylococcus caprae\u003c/em\u003e were detected only in peripheral keratitis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCausative organisms of bacterial keratitis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCausative organism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePeripheral\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSerratia marcescens\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMoraxella\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStaphylococcus capitis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eEnterobacter\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStaphylococcus caprae\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePropionibacterium acnes\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStaphylococcus hominis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed organisms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther organism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo growth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e was the most common causative organism in patients with central and peripheral bacterial keratitis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eRCE: recurrent corneal erosion\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eKP: keratoplasty\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAntibiotics susceptibility of bacterial keratitis\u003c/h2\u003e \u003cp\u003eVancomycin was the most susceptible (n\u0026thinsp;=\u0026thinsp;68, 56.2%) and least resistant (n\u0026thinsp;=\u0026thinsp;0, 0%) antibiotic and ciprofloxacin was second most susceptible (n\u0026thinsp;=\u0026thinsp;51, 42.1%) and second least resistant (n\u0026thinsp;=\u0026thinsp;18, 14.9%) antibiotic in patients with bacterial keratitis. There were no results in every antibiotic susceptibility test from 46 (38.0%) to 57 (47.1%) patients (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntibiotics susceptibility of bacterial keratitis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInhibitory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResistant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSusceptible\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo result\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErythromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenicilline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetracycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVancomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eVancomycin was the most susceptible and least resistant antibiotic and ciprofloxacin was second most susceptible and the second least resistant antibiotic in patients with bacterial keratitis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the effectiveness of antibiotics\u003c/h2\u003e \u003cp\u003eDuration of treatment and BCVA after treatment (1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 months and 0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 logMAR) in the gatifloxacin group were significantly better than those (2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 and 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) in the moxifloxacin group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group (n\u0026thinsp;=\u0026thinsp;30, 42.9%) was higher than that in the moxifloxacin group (n\u0026thinsp;=\u0026thinsp;15, 37.5%). And the percentage of duration of treatment greater than 3 months in the gatifloxacin group (n\u0026thinsp;=\u0026thinsp;13, 18.5%) was less than that in the moxifloxacin group (n\u0026thinsp;=\u0026thinsp;9, 22.5%). The other groups were not incomparable with in the gatifloxacin and moxifloxacin groups because of the small number of cases. But the duration of treatment with vancomycin and ceftazidime ranged from 1 month to 3 months because of the initial severe condition of bacterial keratitis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBacterial keratitis is a serious ophthalmic emergency that is one of the leading causes of corneal blindness and visual loss.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Early diagnosis and treatment of appropriate antimicrobial medication is very important to prevent its fatal complications.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Bacterial keratitis is far more common in developing nations, where access to hospital facilities is limited and hazardous jobs such as farming and agriculture are more common.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eZhang Z et al. reported that the overall positive culture rate was 47% (95% confidence interval, 42\u0026ndash;52%). In a meta-analysis of bacterial keratitis, gram-positive cocci were the most common (62%), followed by gram-negative bacilli (30%), gram-positive bacilli (5%), and gram-negative cocci (5%).[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In our report, the overall positive gram stain rate was 76% and the positive culture rate was 78%. The culture rate of bacterial keratitis in our study was much higher than in other reports. Most of the bacterial keratitis was gram-positive (n\u0026thinsp;=\u0026thinsp;85, 70%) and the gram-negative is only 6% (7 eyes) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Most of the results of culture were gram-positive cocci (GPC) (n\u0026thinsp;=\u0026thinsp;63, 52%) and gram-negative bacilli (GNB) (n\u0026thinsp;=\u0026thinsp;21, 17%). Gram positive bacilli (GPB) (n\u0026thinsp;=\u0026thinsp;6, 5%) and mixed infection with GPC and GNB (n\u0026thinsp;=\u0026thinsp;5, 4%) were also detected (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The bacterial strains of the culture in our study were similar to those in earlier reports.\u003c/p\u003e \u003cp\u003eThe bacteriological profile and causation of bacterial keratitis differ based on geographic region, referral patterns, and other factors.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] But \u003cem\u003eStaphylococcus epidermidis, Staphylococcus aureus\u003c/em\u003e, other \u003cem\u003ecoagulase-negative Staphylococcus species, Streptococcus pneumonia\u003c/em\u003e, and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e were describeded to be the most prevalent organisms in bacterial keratitis.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] But Palmer GS. Et al. reported that \u003cem\u003ePseudomonas\u003c/em\u003e was the most common bacterial cause of infected keratitis, followed by \u003cem\u003eStaphylococcus and Bacillus\u003c/em\u003e.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] In our study, \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;43, 35.5%) was also the most common causative organism in patients with central and peripheral bacterial keratitis.\u003c/p\u003e \u003cp\u003eThe characteristics of central keratitis were reported to be larger ulcerations (\u0026gt;\u0026thinsp;4 mm\u003csup\u003e2\u003c/sup\u003e) with inflammation and more often positive culture results.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] In our study, bacterial keratitis consisted of central keratitis (87 eyes, 72.0%) and peripheral keratitis (34 eyes, 38.0%).\u003c/p\u003e \u003cp\u003eThe central keratitis and peripheral keratitis had different gram stain pattern. Most of the central bacterial keratitis was gram-positive (n\u0026thinsp;=\u0026thinsp;57, 65%) and the gram-negative was only 8% (7 eyes) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Most of the peripheral bacterial keratitis was Gram positive (n\u0026thinsp;=\u0026thinsp;29, 85%) and the Gram negative was none (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eThe central keratitis and peripheral keratitis also had different pathogen patterns. \u003cem\u003eMoraxella, Pseudomonas aeruginosa, Staphylococcus aureus, Propionibacterium acnes, Staphylococcus hominis\u003c/em\u003e, and mixed organisms were detected only in central keratitis. \u003cem\u003eEnterobacter\u003c/em\u003e and \u003cem\u003eStaphylococcus caprae\u003c/em\u003e were detected only in peripheral keratitis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePredisposing factors for bacterial keratitis were reported to be ocular surface disease (26/57\u0026thinsp;=\u0026thinsp;45.6%), contact lens wear (26/57\u0026thinsp;=\u0026thinsp;45.6%),[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and previous trauma (5/57\u0026thinsp;=\u0026thinsp;8.8%).[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] On the other hand, the most common cause of bacterial keratitis was ocular trauma (n\u0026thinsp;=\u0026thinsp;29, 24.0%), followed by contact lenses (n\u0026thinsp;=\u0026thinsp;18, 14.9%), ocular disease (n\u0026thinsp;=\u0026thinsp;8, 6.6%), and ocular surgery (n\u0026thinsp;=\u0026thinsp;8, 6.6%) in our result. The unknown causes were the most common in our study (n\u0026thinsp;=\u0026thinsp;49, 40.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAustin A. et al. reported that the initial treatment of bacterial keratitis differs from clinicians in the USA being more likely to use fortified antibiotics versus fluoroquinolone monotherapy.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Fluoroquinolones prescribed as an empiric first-line treatment of bacterial keratitis are at least as effective as fortified antibiotics.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] But, resistance to fluoroquinolones was common among bacterial keratitis.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] And \u003cem\u003eS. epidermidis\u003c/em\u003e strains isolated from three ocular pathologies were resistant to gatifloxacin and moxifloxacin due to mutations on the \u003cem\u003egyrA\u003c/em\u003e and \u003cem\u003eparC\u003c/em\u003e genes.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTherefore, we usually use fluoroquinolone as an empirical therapy in common bacterial keratitis, but fortified antibiotics such as vancomycin and ceftazidime were used in severe corneal infiltration[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] in the initial examination. Vancomycin was the most susceptible and least resistant antibiotic and ciprofloxacin was second most susceptible and the second least resistant antibiotic in patients with bacterial keratitis (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). There was no treatment failure in both of the empirical therapies with fluoroquinolone or fortified antibiotics in our study (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of effectiveness of antibiotics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGatifloxacin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMoxifloxacin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVancomycin ceftazidime\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstitution to fortified antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment time (Month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment less than 1 Month (eyes, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment more than 3 Months (eyes, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA before treatment (logMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA after treatment (logMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e*0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment Failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBCVA: best corrected visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003elogMAR : Logarithm of the Minimum Angle of Resolution\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDuration of treatment and BCVA after treatment in the gatifloxacin group were significantly better than those in the moxifloxacin group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group was higher than that in the moxifloxacin group. And the percentage of duration of treatment greater than 3 months in the gatifloxacin group was less than that in the moxifloxacin group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. *: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was a decrease in resistance to some of the fluoroquinolones.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The fourth-generation fluoroquinolones (gatifloxacin and moxifloxacin) were found to be more effective against \u003cem\u003eStaphylococcus aureus\u003c/em\u003e isolates resistant to ciprofloxacin, ofloxacin, and levofloxacin.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Moxifloxacin and gatifloxacin were the most effective against MRSA bacteria in both planktonic and biofilm forms.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] And gatifloxacin 0.3% or moxifloxacin 0.5% was very safe and had no epithelial damage in normal human corneas after instillation.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Gatifloxacin had a different antibacterial susceptibility compared with moxifloxacin. Moxifloxacin had lower MICs for the majority of gram-positive bacteria, whereas gatifloxacin had lower MICs for the majority of gram-negative bacteria.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] In our study, duration of treatment and BCVA after treatment (1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 months and 0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10 logMAR) in the gatifloxacin group were significantly better than those (2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 and 0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13) in the moxifloxacin group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The percentage of duration of treatment less than 1 month in the gatifloxacin group (n\u0026thinsp;=\u0026thinsp;30, 42.9%) was higher than that in the moxifloxacin group (n\u0026thinsp;=\u0026thinsp;15, 37.5%). And the percentage of duration of treatment greater than 3 months in the gatifloxacin group (n\u0026thinsp;=\u0026thinsp;13, 18.5%) was less than that in the moxifloxacin group (n\u0026thinsp;=\u0026thinsp;9, 22.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA limitation of our investigation was that a multicenter clinical trial with a bigger sample size and a longer follow-up period was required to observe the bacterial spectrum and antimicrobial susceptibility pattern of peripheral and central bacterial keratitis.\u003c/p\u003e \u003cp\u003eIn conclusion, there was a different bacterial spectrum in central and peripheral keratitis. The most common cause of bacterial keratitis was ocular trauma (n\u0026thinsp;=\u0026thinsp;29, 24.0%), followed by contact lens (n\u0026thinsp;=\u0026thinsp;18, 14.9%). Both of fortified antibiotics and fluoroquinolone were effective for empirical therapy. Gatifloxacin was more effective for early corneal healing and recovery of visual acuity than moxifloxacin.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGPC: gram-positive cocci, GNB : gram-negative bacilli, GPB: gram-positive bacilli (GPB)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDJ was involved in analysis and interpretation of data and drafting the manuscript. DJ, SYH, HSK, ECK made contribution to acquisition of data and drafting. ECK contributed to conception and design, analysis and interpretation of data, drafting and revising the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government(MSIT) (No. 2022R1F1A1069218) and grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health and Welfare, Republic of Korea (No. HC23C0130).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board at Bucheon St. Mary’s Hospital (HC22RASI0099); the informed consent was waived. All clinical investigations have been conducted according to the principles expressed in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors do not have any conflicts of interest or proprietary interests in the contents of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCabrera-Aguas M, Khoo P, Watson SL: \u003cstrong\u003eInfectious keratitis: A review\u003c/strong\u003e. \u003cem\u003eClin Exp Ophthalmol \u003c/em\u003e2022, \u003cstrong\u003e50\u003c/strong\u003e(5):543-562.\u003c/li\u003e\n\u003cli\u003eDurand ML, Barshak MB, Chodosh J: \u003cstrong\u003eInfectious Keratitis in 2021\u003c/strong\u003e. \u003cem\u003eJama \u003c/em\u003e2021, 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treatment of central and peripheral ulcers\u003c/strong\u003e. \u003cem\u003eBr J Ophthalmol \u003c/em\u003e1998, \u003cstrong\u003e82\u003c/strong\u003e(2):137-145.\u003c/li\u003e\n\u003cli\u003eYang YS, Chun JW, Koh JW: \u003cstrong\u003eKeratitis with Elizabethkingia meningoseptica Occurring after Contact Lens Wear: A Case Report\u003c/strong\u003e. \u003cem\u003eKorean J Ophthalmol \u003c/em\u003e2013, \u003cstrong\u003e27\u003c/strong\u003e(2):133-136.\u003c/li\u003e\n\u003cli\u003eSong YY, Ahn M, Cho NC, You IC: \u003cstrong\u003eA Case of Rothia mucilaginosa Keratitis in South Korea\u003c/strong\u003e. \u003cem\u003eKorean J Ophthalmol \u003c/em\u003e2017, \u003cstrong\u003e31\u003c/strong\u003e(5):460-461.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"bacterial keratitis, bacterial spectrum, antimicrobial susceptibility, central keratitis, peripheral keratitis","lastPublishedDoi":"10.21203/rs.3.rs-4695589/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4695589/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To evaluate the bacterial spectrum and antimicrobial susceptibility pattern of bacterial keratitis in South Korea for ten years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 143 eyes of 143 patients who have been diagnosed with bacterial keratitis from January 2010 to April 2019 were retrospectively enrolled. Corneal scraping was done for Gram stain in all patients, and cultures were plated on blood, chocolate, Sabouraud dextrose agar, and thioglycolate broth. Empirical fourth generation fluoroquinolone or fortified vancomycin and ceftazidime were treated for every patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOcular trauma (n=29, 24.0%) and contact lens (n=18, 14.9%) were the most common causes in patients with bacterial keratitis. Most of the bacterial keratitis was gram-positive (n=85, 70%) and the gram-negative is only 6% (7 eyes). Most of central and peripheral keratitis were Gram positive (n=57, 65% and n=29, 85%). There was no gram-negative stain in peripheral keratitis. Vancomycin and ciprofloxacin were the most susceptible (n=68, 56.2% and n=51, 42.1%) and least resistant (n=0, 0% and n=18, 14.9%) in the antibiotic susceptibility test. Treatment time (month) and best corrected visual acuity after treatment in the gatifloxacin group were better than those in the moxifloxacin group (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe most common cause of bacterial keratitis was ocular trauma and contact lenses. There was a different bacterial spectrum in central and peripheral keratitis. Gatifloxacin was more effective for early corneal healing and recovery of visual acuity than moxifloxacin.\u003c/p\u003e","manuscriptTitle":"Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Peripheral and Central Bacterial Keratitis in South Korea for Ten Years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-10 12:10:26","doi":"10.21203/rs.3.rs-4695589/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62765c59-f2d5-4960-a2bb-668de906998e","owner":[],"postedDate":"August 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T08:25:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-10 12:10:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4695589","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4695589","identity":"rs-4695589","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}