Incidence, Clinical Profile, and Management of Keratitis Caused by Uncommon Species of Pseudomonas at a Tertiary Eye Care Center

Abstract

Purpose: The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa) at a tertiary eye care center. Methods: Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes. Results: Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida, 26.7% as Pseudomonas stutzeri, 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes. We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer. Conclusions: Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.