MICROBIAL ETIOLOGY AND PREDISPOSING FACTORS AMONG PATIENTS HOSPITALIZED FOR CORNEAL ULCERATION

Objective: To report the spectrum of microorganisms causing corneal ul ceration in patients treated on an inpatient basis and to characterize the predisposing factors. Design: Case series. Setting: Large univers ity-affiliated hospital in Toronto, Patients: All inpatients with corn eal ulcers managed between February 1991 and February 1993 (n = 95). R esults: Coagulase-negative staphylococci (30% of the 60 culture-positi ve cases), Staphylococcus aureus (23%), Streptococcus pneumoniae (12%) , Pseudomonas aeruginosa (12%) and Moraxella (7%) were the predominant isolates. Previous eye surgery (cataract extraction in 30 cases [32%] , penetrating keratoplasty in 12 [13%] and both procedures in 9 [9%]) was a common predisposing factor. Eleven cases (12%) were associated w ith the use of contact lenses, in all cases extended wear soft contact lenses; six patients wore bandage lenses and five wore contact lenses for cosmetic reasons. Pseudomonas was the predominant isolate among c ontact lens wearers (four cases). Most of the 95 cases involved older patients (average age 62.5 years) with concomitant eye or systemic dis ease. Sixteen patients (17%) ultimately required penetrating keratopla sty. Conclusions: Recognition of the risk factors for corneal ulcerati on and prompt, intensive therapy are important to decrease the morbidi ty associated with this potentially binding disease.