THE ROLE OF SMEARS, CULTURES, AND ANTIBIOTIC-SENSITIVITY TESTING IN THE MANAGEMENT OF SUSPECTED INFECTIOUS KERATITIS

Purpose: To examine the role of routine smears, cultures, and antibiot ic sensitivity testing in the treatment of suspected infectious kerati tis. Methods: A retrospective chart and laboratory data review was per formed for 81 consecutive patients seen in the Los Angeles County/Univ ersity of Southern California Department of Ophthalmology between June 1991 and December 1993 with a primary diagnosis of community-acquired infectious keratitis. No patients were treated with antibiotics befor e evaluation in the authors' department, and all underwent corneal scr apings for gram-stain and bacterial, fungal, and mycobacterium culture s. Ulcers were classified as moderate or severe. All initially were tr eated as inpatients with a regimen including fortified cefazolin and a fortified aminoglycoside. Results: Of 81 patients, 74 ulcers were eit her culture- negative (n = 18) or grew bacteria (n = 56). Fungal infec tion was suggested in seven patients. Of the nonfungal ulcers, 33 were classified as moderate, and 41 as severe; all moderate ulcers improve d without requiring a modification in antibiotic treatment, whereas 3 severe ulcers required a change in treatment. Conclusion: Most communi ty-acquired bacterial ulcers resolve with broad spectrum empiric thera py. Alternatives to universal culture and sensitivity testing that mig ht be considered include selectively performing cultures for more seve re or suspected non-bacterial ulcers or routinely obtaining cultures i n all cases, but pursuing identification and sensitivity studies only when those data are required for therapy modification.