Outbreak of Gram-positive bacterial keratitis associated with epidemic keratoconjunctivitis in neonates and infants

Abstract

Objectives To report the clinical characteristics of bacterial keratitis associated with epidemic keratoconjunctivitis (EKC) and to evaluate the risk factors for bacterial keratitis development in eyes with EKC. Methods After 108 patients diagnosed as EKC were retrospectively reviewed, clinical characteristics and incidence of bacterial keratitis-associated EKC were described. To analyse the effect of steroid use and the methicillin-resistant Staphylococcus aureus (MRSA) colonization in conjunctiva on developing bacterial keratitis, HCU-stayed children (n = 43) were divided into two groups: those with and those without bacterial keratitis. Other risk factors such as gestational age, duration of hospitalization, MRSA colonization rate of other sites, and interval between follow-ups were evaluated in neonates who stayed in a neonatal intensive care unit (NICU; n = 29). Results Eight out of nine bacterial keratitis developed in HCU-stayed children. All the eight cases of bacterial keratitis occurred in neonates and infants. MRSA keratitis was found in seven hospitalized infants. The incidence of bacterial keratitis was significantly higher in HCU-stayed children than in outpatients (P = 0.03), although it never occurred in HCU-stayed adults. The culture-positive rate of MRSA in conjunctiva (P = 0.047) and topical use of steroid (P = 0.01) were significantly higher in HCU-stayed children who carried bacterial keratitis. The incidence of bacterial keratitis was significantly related with the longer interval of follow-up in early EKC period in NICU in patients (P = 0.009). Conclusions Infants and neonates show high tendency of MRSA keratitis accompanied with EKC, especially if they were in HCU, applied topical steroid or followed with long interval. Eye (2009) 23, 1059-1065; doi:10.1038/eye.2008.234; published online 1 August 2008