Nama : Pembimbing :

Monika Anneke, S.Ked dr. Esma Kindangen, Sp.M

ABSTRAK
 Introduction

• In East Africa, particularly in

Ethiopia, bacterial keratitis
is a major cause of blindness
• Bacterial keratitis is an
ophthalmic emergency
that needs immediate
treatment
Ocular trauma or ocular
surface diseases

the incidence of contact lens

related keratitis
Pseudomonas
aeruginosa

which can cause

corneal perforation
<24 hours after onset
TUJUAN

In Ethiopia, there is a
scarcity of published Identify the
risk factors of
data on the spectrum spectrum of
bacterial keratitis
of etiologic agents bacterial aetiology
and risk factors of
bacterial keratitis.
to assess the in-vitro
antimicrobial
Jimma University susceptibility of
Specialized Hospital in these bacterial
Oromia, Southwest isolates
Ethiopia
Materials and Methods
included 24
A prospective
corneal scrapings
study(Januari 2012
for bacteriological
s/d Juni 2012)
evaluation

Transported collected

Processed in
microbiologically
corneal traumas

contact lens wear

herpetic keratitis

ocular surface diseases, lagophthalmos

steroid eye drops

use of contaminated medications

blepharitis

history of systemic diseases particularly diabetes

mellitus
 ophthalmologists
examined on the slit- topical anesthetic collected corneal
lamp bio-microscope (0.5% tetracaine) scrapings with a 20
gauge sterile needle

Two corneal
sheep blood agar
scrapings were
(5%), chocolate agar,
incubation obtained from each
manitol salt agar &
case with separate
MacConkey agar
needle

Stored at temperature
37ºC with CO2 5-10% The plates were
and All other media examined after 24 and
37ºC in aerobic 48 hours
conditions
• In vitro antibiotic susceptibility testing of the bacterial isolates
was performed by Kirby-Bauer disc diffusion method
RESULTS

Keratitis involved
right eye only  16 patients
left eye only  3 patients
Both eyes  5 patients
The location of the
infiltrates Ulceration depth
The location of the < 30%  14 patients
infiltrates was central  18
cases 30 % - 60%  9 patients
60%  1 patients
The diameter of the Hypopyon was present
corneal infiltrate
in 4(16.7%) cases
≤ 1 mm  12 patients
1-2 mm  7 patients
> 2 mm  5 patients
• Of the 24 corneal scrapings
subjected to culture, 20 (83.3%) had
bacterial growth.
• In positive cultures, P. aeruginosa
(41.7%) was the most common
pathogen, followed by S. aureus
(20.8%).
Visual acuity of bacterial keratitis patients (n= 24)
at initial presentation (admission) and discharge

• Nineteen (79.2%) of our

patients had healed ulcers
with treatment with no
significant visual disability.
One patient had progressed
to endophthalmitis and was
subjected to inadvertent
evisceration.
Sangat Rentan
RESISTEN
Discussion

• Bacterial keratitis ophthalmic emergency that needs

immediate institution of treatment.
• In the absence of laboratory diagnosis initial
therapy intensive treatment broad spectrum
antibiotics
• Specific therapy should be based on laboratory data
which identify the causative agents and provide
antibacterial susceptibility result
• We found that corneal trauma is the commonest predisposing
factor in our patients. This is consistent with similar studies.
However, other studies reported contact lens wear .
• In positive cultures, P. aeruginosa (41.7%) was the most common
pathogen, which is similar to the results of several other studies,
followed by S. aureus (20.8%).
• trauma of the corneal  infeksi Pseudomonas  produces
exotoxin A  causes tissue necrosis  corneal ulceration
However, other similar studies reported S. • The variation with the
pneumoniae as the most common isolate in
bacterial keratitis
patient population
• Health of the cornea
One study in India [3] reported P. aeruginosa • Geographic location and
and S. pneumoniae as a predominant climate
isolates of bacterial keratitis with equal
frequency.

Other studies reported Staphylococcus spp.

as a predominant isolates.
• The susceptibility of vancomycin against S. aureus was 80.0% (4 of
5). This finding is in agreement with study conducted in India and
Ethiopia.
• The sensitivity of gentamicin against Gram-negative bacilli was
84.6% (11 of 13 isolates) and the coverage of this antibiotic for P.
aeruginosa was 90.0% (9 of 10 isolates). This is comparable with
similar studies done in Ethiopia, Nigeria, and Iran. However, study
conducted in India reported low sensitivity of gentamicin against
P. aeruginosa.
• Gentamicin covered against 4(30.8%) of the 7 Gram-positive cocci
isolates and had high coverage against S. aureus (90.0%; 9 of 10).
• Amikacin had high coverage against S. aureus (80.0%; 4 of 5). This
is consistent with similar studies conducted in India
Cause of antibiotic resistance

antibiotic-prescribing
characteristics practices including
health care
the widespread use
of the pathogens guidelines
of systemic
antibiotics,

misuse of antibiotics
include improper for viral and other extended duration
dosage regimen non-bacterial of therapy
infections
• In Ethiopia, it is in common practice that antibiotics can be purchased
without prescription, which leads to misuse of antibiotics.This may
contribute to the emergence and spread of antimicrobial resistance
• Other factors may include availability of the suboptimal quality or
substandard antimicrobial drugs
• Increased usage of a particular antimicrobial agent
• Poor Sanitation
• Contaminated food and cross-contamination from humans or animals
• As a result the susceptibility patterns of bacteria to various
antimicrobial agents may vary from place to place and in the same place
from time to time
• P. aeruginosa, which constitutes 76.9% of the Gram
negative bacteria were highly sensitive towards amikacin
(8;80.0%), ciprofloxacin (8; 80.0%), and ceftriaxone (7;
70.0%).
• Gram-positives were susceptible to gentamicin
vancomycin, ciprofloxacin and doxycycline.
KESIMPULAN

• Corneal trauma was the most common risk factor for bacterial
kera-titis followed by blepharitis.
• Bacteriological analysis of corneal scrapings also re-vealed that P.
aeruginosa was the most common isolate followed by S. aureus;
• The antibiotic with the highest susceptibility was ciprofloxacin.
• As drug resis-tance among bacterial pathogens is an evolving
process, routine surveillance and monitoring studies should be
conducted to provide an update and most effective empirical
treatment for bacterial keratitis.