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Multi-Drug Resistant Pseudomonas Keratitis Clinical Characteristics and Associated Features Jayesh Vazirani Merle Fernandes L V Prasad Eye Institute Visakhapatnam, India Jayesh Vazirani Merle Fernandes L V Prasad Eye Institute Visakhapatnam, India The authors have no financial interests to disclose

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Purpose To study Clinical characteristics Risk factors For Multi-Drug Resistant (MDR) Pseudomonas aeruginosa keratitis

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Methods Case Control study design (2007-2014) Definitions Pseudomonas aeruginosa keratitis Clinical features of microbial keratitis Significant growth (two solid media / one solid and one liquid medium / correlation between smear and culture) of Pseudomonas aeruginosa on culture from corneal scrapings Multi-drug resistance Resistance to 3 or more classes of antimicrobial drugs, as tested by Kirby-Bauer disc diffusion method

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Methods Inclusion criteria: Cases - MDR Pseudomonas keratitis Controls - Drug sensitive Pseudomonas keratitis Baseline characteristics studied Age, gender, duration of symptoms, topical medication used prior to presentation, trauma, contact lens use, ocular surface disease, prior ocular surgery A multivariate logistic-regression model with stepwise elimination using Akaike information criteria (AIC) was used to assess the association of Cases and Controls with baseline characteristics Clinical course and outcomes also compared

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Results MDR Pseudomonas keratitis Drug Sensitive Pseudomonas keratitis No of episodes 2367 No of eyes 2067 No of patients 1767 Bilateral cases 30 Median Age (years) 5449 % Male 52.9467.16 Graft infiltrates (%) 9 (39.13)21 (31.34) Median duration of symptoms (days) 74

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Results MDR Pseudomonas keratitis Drug Sensitive Pseudomonas keratitis Topical Steroid use (%) 12 (52.17)23 (32.32) Lubricant ointment use (%) 18 (78.26)26 (38.80) Trauma (%) 2 (10)8 (11.94) Surgery (%) 11 (55)22 (32.83) Ocular surface disease (%) 18 (90)24 (35.82) Contact lens use (%) 5 (25)5 (7.46) Median Lesion size (mm) 85.4

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Univariate Analysis p values

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Multivariate Analysis p values

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Association with Multi-Drug Resistance Multivariate Odds Ratio 95% Confidence Intervals p Value Contact lens use 11.14(1.31 94.43)0.027 Ocular surface disease 37.29(3.89 357.2)0.002 Lubricant ointment use 7.65(1.57 37.2)0.012 Univariate Odds Ratio 95% Confidence Intervals p Value Contact lens use3.44(0.9 - 13.23)0.072 Ocular surface disease 18.81(4.06 87.21)