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Peer-reviewedCC BY 4.0Clinics

Shifting microbial profiles and antimicrobial susceptibility in infectious keratitis: a 13-year longitudinal analysis at a Brazilian tertiary center

  • Juliana Mika Kato1
  • Maura Salaroli Oliveira2
  • Luiza Manhezi Shin de Oliveira1
  • Tatiana Tanaka1
  • Gustavo Sakuno1
  • Luciana Santana3
  • Evangelina da Motta Pacheco Alves de Araujo3
  • Joyce Hisae Yamamoto1
  • Ruth Miyuki Santo1
  1. 1Department of Ophthalmology, LIM-33, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
  2. 2Division of Infection Control, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
  3. 3Central Laboratory Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Abstract

Background/Aims: Infectious keratitis is a sight-threatening disease often managed with empiric antibiotics. Continuous monitoring of causative agents and resistance patterns is essential to detect shifts in susceptibility and optimize treatment protocols. This study analyzed the etiology and antibiotic susceptibility trends of microbial keratitis at a major tertiary referral center over a 13-year period.

Methods: Retrospective analysis of corneal scrapings from patients clinically diagnosed with infectious keratitis between January 2013 and December 2025. Cases were divided into two periods (2013–2019 and 2020–2025) to evaluate temporal trends. Statistical analyses included Bonferroni-corrected chi-square/Fisher’s exact tests and the Cochran-Armitage trend test.

Results: Among 649 corneal scrapings, 343 (52.9%) were culture-positive, yielding 420 isolates (18.1% polymicrobial). Bacteria predominated (88.8%), comprising 56.9% Gram-Positive (GP) and 31.9% Gram-Negative (GN) isolates. Coagulase-negative Staphylococci were the most frequent GP (21.4%), while Pseudomonas aeruginosa (11.4%) was the leading GN. Fungi comprised for 10.2%. Longitudinal analysis revealed significant reductions in Cutibacterium acnes (adjusted p < 0.001) and Serratia marcescens (adjusted p = 0.009), a downward trend in fungal isolation (ptrend = 0.010) and a marginal decline in ciprofloxacin susceptibility among GN (ptrend = 0.056). All GP isolates demonstrated 100% in vitro susceptibility to vancomycin. Methicillin resistance was identified in 19.4% of S. aureus and 43.1% of coagulase-negative Staphylococci.

Conclusion: The microbiological profile of infectious keratitis showed significant temporal shifts, including a reduction in C. acnes and a downward trend in fungal isolation. While Gram-positive and Gram-negative organisms maintained high susceptibility to vancomycin and amikacin, respectively, a marginal, non-statistically-significant decline in ciprofloxacin susceptibility among Gram-negative isolates warrants continuous microbiological surveillance.

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Cite

BibTeXRIS
BibTeX
@article{kato2026shifting,
  title = {{Shifting microbial profiles and antimicrobial susceptibility in infectious keratitis: a 13-year longitudinal analysis at a Brazilian tertiary center}},
  author = {Juliana Mika Kato and Maura Salaroli Oliveira and Luiza Manhezi Shin de Oliveira and Tatiana Tanaka and Gustavo Sakuno and Luciana Santana and Evangelina da Motta Pacheco Alves de Araujo and Joyce Hisae Yamamoto and Ruth Miyuki Santo},
  journal = {Clinics},
  year = {2026},
  month = oct,
  doi = {10.1016/j.clinsp.2026.101220},
  url = {https://doi.org/10.1016/j.clinsp.2026.101220},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Shifting microbial profiles and antimicrobial susceptibility in infectious keratitis: a 13-year longitudinal analysis at a Brazilian tertiary center
AU  - Juliana Mika Kato
AU  - Maura Salaroli Oliveira
AU  - Luiza Manhezi Shin de Oliveira
AU  - Tatiana Tanaka
AU  - Gustavo Sakuno
AU  - Luciana Santana
AU  - Evangelina da Motta Pacheco Alves de Araujo
AU  - Joyce Hisae Yamamoto
AU  - Ruth Miyuki Santo
PY  - 2026
DA  - 2026/10/23
JO  - Clinics
DO  - 10.1016/j.clinsp.2026.101220
UR  - https://doi.org/10.1016/j.clinsp.2026.101220
AB  - Background/Aims: Infectious keratitis is a sight-threatening disease often managed with empiric antibiotics. Continuous monitoring of causative agents and resistance patterns is essential to detect shifts in susceptibility and optimize treatment protocols. This study analyzed the etiology and antibiotic susceptibility trends of microbial keratitis at a major tertiary referral center over a 13-year period.  Methods: Retrospective analysis of corneal scrapings from patients clinically diagnosed with infectious keratitis between January 2013 and December 2025. Cases were divided into two periods (2013–2019 and 2020–2025) to evaluate temporal trends. Statistical analyses included Bonferroni-corrected chi-square/Fisher’s exact tests and the Cochran-Armitage trend test.  Results: Among 649 corneal scrapings, 343 (52.9%) were culture-positive, yielding 420 isolates (18.1% polymicrobial). Bacteria predominated (88.8%), comprising 56.9% Gram-Positive (GP) and 31.9% Gram-Negative (GN) isolates. Coagulase-negative Staphylococci were the most frequent GP (21.4%), while Pseudomonas aeruginosa (11.4%) was the leading GN. Fungi comprised for 10.2%. Longitudinal analysis revealed significant reductions in Cutibacterium acnes (adjusted p < 0.001) and Serratia marcescens (adjusted p = 0.009), a downward trend in fungal isolation (ptrend = 0.010) and a marginal decline in ciprofloxacin susceptibility among GN (ptrend = 0.056). All GP isolates demonstrated 100% in vitro susceptibility to vancomycin. Methicillin resistance was identified in 19.4% of S. aureus and 43.1% of coagulase-negative Staphylococci.  Conclusion: The microbiological profile of infectious keratitis showed significant temporal shifts, including a reduction in C. acnes and a downward trend in fungal isolation. While Gram-positive and Gram-negative organisms maintained high susceptibility to vancomycin and amikacin, respectively, a marginal, non-statistically-significant decline in ciprofloxacin susceptibility among Gram-negative isolates warrants continuous microbiological surveillance.
SN  - 1807-5932
SN  - 1980-5322
ER  -