Microbial Etiology and Antimicrobial Resistance among Patients with Infective Keratitis at Two Tertiary Eye Hospitals in Dar-Es-Salaam

Abstract

Background Infective keratitis is a commonly encountered blinding ocular emergency; it is a major cause of corneal related blindness. The etiology can be polymicrobial and tend to vary with time and geographic location. Knowledge of local microbial etiology and drug resistance on infective keratitis is essential for selection of appropriate antimicrobial agents there by improving quality of care and outcomes of treatment for patients with infective keratitis. Aim To determine microbial etiology and antimicrobial resistance among patients with infective keratitis at Muhimbili national hospital (MNH) and Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) Hospital. Methodology; Hospital based cross sectional study was conducted at MNH & CCBRT hospitals among adult patients with infective keratitis from July to December 2020. Consecutive sampling was used to recruit 58 participants. Infective keratitis was defined as an inflammation of the cornea characterized by an ulcer or epithelial defect with infiltrates associated with signs and symptoms of ocular inflammation. Structured questionnaire was used to obtain the demographics and associated factors for infective keratitis of the participant and cornea-scrapping specimens were taken for microbiology laboratory tests. Data was analyzed using SPSS version 23. Results; This study involved 58 participants attended at MNH and CCBRT during the study period who were diagnosed to have infective keratitis, majority of the participants were males 65.5% .The median age of the participant was 36.30 years with a range of 18years to 80years, majority were from Dar es salaam 74.1% and most of the participants 56.9% came late with blind eyes VA less than 1.301logMAR. Microbial etiology for infective keratitis in this study was bacteria in 84.5% of the participants. The commonest bacteria isolate was staphylococcal aureus in 36.1% of the participants. The leading associated factor for infective keratitis was history of topical steroid use in 41.4% of the participants. The sensitivity of antimicrobial was highest with floroquinolone by 100%, whereas the highest resistance was shown by penicillin’s by 100%. Conclusion and Recommendations. Microbial etiology for infective keratitis at Dar-es-salaam is mostly bacterial with variable sensitivity to the commonly used Antibiotics and the leading associated factor for infective keratitis was topical steroid use. Therefore Floroqunolone or aminoglycoside monotherapy should be used in the initial ttreatment of infective keratitis in Dar es Salaam, due to their higher senstivity levels and initiatives should be taken to control over the counter corticosteroid use for ocular pathologies.