The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis

Ophthalmology. 1996 Jan;103(1):23-8. doi: 10.1016/s0161-6420(96)30738-0.


Purpose: To examine the role of routine smears, cultures, and antibiotic sensitivity testing in the treatment of suspected infectious keratitis.

Methods: A retrospective chart and laboratory data review was performed for 81 consecutive patients seen in the Los Angeles County/University of Southern California Department of Ophthalmology between June 1991 and December 1993 with a primary diagnosis of community-acquired infectious keratitis. No patients were treated with antibiotics before evaluation in the author's department, and all underwent corneal scrapings for gram-stain and bacterial, fungal, and mycobacterium cultures. Ulcers were classified as moderate or severe. All initially were treated as inpatients with a regimen including fortified cefazolin and a fortified aminoglycoside.

Results: Of 81 patients, 74 ulcers were either culture- negative (n=18) or grew bacteria (n=56). Fungal infection was suggested in seven patients. Of the nonfungal ulcers, 33 were classified as moderate, and 41 as severe; all moderate ulcers improved without requiring a modification in antibiotic treatment, whereas 3 severe ulcers required a change in treatment.

Conclusion: Most community-acquired bacterial ulcers resolve with broad spectrum empiric therapy. Alternatives to universal culture and sensitivity testing that might be considered include selectively performing cultures for more severe or suspected non-bacterial ulcers or routinely obtaining cultures in all cases, but pursuing identification and sensitivity studies only when those data are required for therapy modification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteria / drug effects
  • Bacteria / isolation & purification
  • Bacteriological Techniques
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Cornea / microbiology
  • Corneal Ulcer / drug therapy*
  • Corneal Ulcer / microbiology
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / microbiology
  • Eye Infections, Fungal / drug therapy*
  • Eye Infections, Fungal / microbiology
  • Fungi / drug effects
  • Fungi / isolation & purification
  • Humans
  • Microbial Sensitivity Tests*
  • Mycology / methods
  • Retrospective Studies


  • Anti-Bacterial Agents