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Bacterial keratitis remains a major cause of corneal opacity and loss of vision worldwide. Topical antimicrobial therapy is critical to its management. A number of antimicrobials are available to treat bacterial keratitis, with new antimicrobials occasionally introduced to provide an improved spectrum of activity against emerging or resistant pathogens. For example, cephalosporins were introduced in the 1960s as resistance of Staphylococcus aureus to penicillin became common, while gentamicin was introduced in the 1970s mainly due to an upsurge in Pseudomonas aeruginosa infections, associated with increasing contact lens wear use [1]. The firstand second-generation fluoroquinolones (ciprofloxacin and ofloxacin) have excellent potency against Gram-negative bacteria and reasonably good activity against the Gram-positive bacteria, with little corneal toxicity. When the thirdand fourth-generation fluoroquinolones (levofloxacin, moxifloxacin and gatifloxacin) became available in the early 2000s, they offered a broader Gram-positive cover [1–3]. Despite the success of the firstand second-generation fluoroquinolones, there has been a trend in increased resistance from both S. aureus [4] and P. aeruginosa [5]. The fourth-generation fluoroquinolones, moxifloxacin and gatifloxacin, have not unfortunately been a treatment panacea because of the emergence of resistance [6]. Deciding which antimicrobials to use for the treatment of bacterial keratitis can be challenging. It is important to be aware of the contemporaneous spectrum of likely causative bacteria, as this can vary according to the latitude and the degree of urbanisation of the population studied. Information regarding causative bacteria can only be attained by the collection of samples from the corneal ulcer and their subsequent analysis. Over time, a collection of such isolates provides knowledge not only on the likely bacteria, but also on their changing profiles against antimicrobial agents. This is also important, as treating physicians are often faced with an increasing choice of newer antimicrobial agents. The normal management strategy, if microbial infection is suspected, is to collect samples of corneal tissue for culture and then to initiate antimicrobial treatment empirically. The initial choice of treatment is either a single antimicrobial agent or a combination of antimicrobials providing a broad range of activity against both Gram-positive and Gramnegative bacteria. Once an isolate has been obtained, however, it is then possible to modify the treatment according to the in vitro susceptibility pattern of the isolate. Orlans et al. [7] report on the spectrum of bacteria isolated from cases of keratitis in Oxford and the in vitro susceptibility data over a 10-year period. This type of study provides valuable information for ophthalmologists treating suspected bacterial keratitis in the clinical setting. In this study, they found that the most commonly isolated bacteria were Staphylococci (40.1%), followed by Pseudomonas species (28.5%), other Gram-negative species (17.2%), Streptococci (7.1%), and Corynebacteriacea (6.0%), which S. Kaye (*) :R. Gilbert :H. Sueke Department of Ophthalmology, Royal Liverpool University Hospital, Prescott Street, Liverpool L7 8XP, UK e-mail: s.b.kaye@liv.ac.uk

graefe's archive for clinical and experimental ophthalmology

Orlans HO, Hornby SJ, Bowler IC (2011) In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye Jan 21 [Epub ahead of print] PMID 21252952