Abstract
PURPOSE: Contact lens wear is a major risk factor for infectious keratitis, this study compared demographics, predisposing factors, and microorganisms in infectious keratitis between non-contact lens (NCL), optical contact lens (OCL) and bandage contact lens (BCL) wearers. METHODS: This was a cross-sectional observational study based on retrospectively collected data from a consecutive series of patients with bacterial or fungal keratitis conducted between 2009 and 2020. Data collected included demographics, clinical characteristics, predisposing factors, and associated microorganisms. RESULTS: 536 infectious keratitis were analyzed (NCL: 362, 67.5%; CL: 174, 32.5%). Of the CL-group, 31 (17.8%) used BCL and 143 (82.2%) OCL. NCL-group was older than CL-group (47 vs. 25 years; p < 0.001). Females were more common in CL than NCL-wearers (119/174, 68.4% vs. 143/342, 39.5%; p < 0.001). NCL-group, as compared to CL-wearers, showed more vegetal (34/362, 9.4% vs. 2/174, 1.1%; p < 0.001) and non-vegetal (58/362, 16.0% vs. 6/174, 3.4%; p < 0.001) trauma. The positive culture rate was 56.7% (304/536). NCL-group, as compared to CL-wearers, had more gram-positive (110/362, 54.5% vs. 27/174, 26.5%; p < 0.001), more fungal (50/362, 24.8% vs. 10/174, 9.8%; p = 0.01), and fewer gram-negative (64/362, 31.6% vs. 73/174, 71.6%; p < 0.001). BCL, as compared to OCL, showed more gram-positive (10/31, 55.6% vs. 17/143, 20.2%; p = 0.01) and fewer gram-negative (10/31, 55.6%vs. 63/143, 75.0%; p = 0.01) bacteria. Pseudomonas aeruginosa was the primary bacteria, and Fusarium spp. was the primary fungus. P. aeruginosa was more common in CL-wearers than NCL-group (67/174, 65.7% vs. 46/362, 22.8%; p = 0.02). Gram-negative was associated with OCL use (OR 1.96, CI 1.06-3.64; p = 0.03) and hypopyon (OR 3.39, CI 2.07-5.56; p < 0.001). Vegetal trauma was associated with fungal keratitis (OR 3.11, CI 1.20-8.05; p = 0.02). CONCLUSIONS: CL use and trauma were key predisposing factors for infectious keratitis. P. aeruginosa and Fusarium spp. predominated, with higher P. aeruginosa rates in CL-wearers, fungal infections in NCL-wearers, and more gram-negative isolates in OCL- than in BCL-wearers. These findings provide insight into microbiological trends in Mexico and support targeted preventive strategies.