Association between cytotoxic and invasive Pseudomonas aeruginosa and clinical outcomes in bacterial keratitis.

Journal Article (Journal Article)

OBJECTIVES: To determine whether cytotoxic and invasive Pseudomonas aeruginosa strains differentially influence clinical presentation, outcomes, or therapeutic response in bacterial keratitis. METHODS: Pseudomonas aeruginosa isolates from the National Eye Institute-funded Steroids for Corneal Ulcers Trial were subtyped as cytotoxic or invasive strains. The main outcome measure compared between the 2 subtypes was change in visual acuity at 3 months using Huber robust regression, adjusting for topical corticosteroid treatment. RESULTS: Of 101 confirmed P aeruginosa isolates from the Steroids for Corneal Ulcers Trial, 74 had a classically cytotoxic or invasive genotype. While corneal ulcers caused by genotypically invasive P aeruginosa strains were associated at presentation with significantly better visual acuity than corneal ulcers caused by genotypically cytotoxic P aeruginosa strains when adjusting for the effect of ulcer location (P= .008), invasive ulcers had improved significantly less than cytotoxic ulcers at 3 months (0.35; 95% CI, 0.04-0.66 logMAR; P= .03 [3.5-line difference]). Compared with topical moxifloxacin alone, adjunctive treatment with topical corticosteroids was associated with significantly more improvement in visual acuity in the invasive subgroup (P= .04) but was associated with less improvement in visual acuity in the cytotoxic subgroup (P= .07). CONCLUSIONS: Rational profiling of differentially expressed virulence determinants (eg, cytotoxicity and invasiveness for P aeruginosa) could be used as a tool for decision making in the management of infections to optimize outcomes.

Full Text

Duke Authors

Cited Authors

  • Borkar, DS; Fleiszig, SMJ; Leong, C; Lalitha, P; Srinivasan, M; Ghanekar, AA; Tam, C; Li, WY; Zegans, ME; McLeod, SD; Lietman, TM; Acharya, NR

Published Date

  • February 2013

Published In

Volume / Issue

  • 131 / 2

Start / End Page

  • 147 - 153

PubMed ID

  • 23411878

Pubmed Central ID

  • PMC3796098

Electronic International Standard Serial Number (EISSN)

  • 2168-6173

Digital Object Identifier (DOI)

  • 10.1001/jamaophthalmol.2013.778


  • eng

Conference Location

  • United States