{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:40:48Z","timestamp":1785116448420,"version":"3.55.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal\/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (14%), and <jats:italic>Aspergillus<\/jats:italic> spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN\u2009+\u2009VAN, CAZ\u2009+\u2009VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.259). Their median time-to-epithelialization reached 21, 30, and 30\u00a0days, respectively (log-rank <jats:italic>p<\/jats:italic>\u2009=\u20090.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT)\u2009+\u2009VRC combination compared to VRC (39.1%) or NT (52.6%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.036). Their median time-to-epithelialization was 65, 60, and 22\u00a0days, respectively (log-rank <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The VRC group required more interventions (60.9%) than NT\u2009+\u2009VRC-treated group (11.1%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.018). In 23 MFBK patients, none healed using NT\u2009+\u2009CAZ\u2009+\u2009VAN, while 50% healed using VRC\u2009+\u2009CAZ\u2009+\u2009VAN (<jats:italic>p<\/jats:italic>\u2009=\u20090.052). Regimens had comparable visual outcomes and complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN\u2009+\u2009VAN in severe BK. Due to better outcomes, we recommend NT\u2009+\u2009VRC in severe FK.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022\u2013 Retrospectively registered, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05655689?cond=NCT05655689.&amp;draw=2&amp;rank=1\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05655689?cond=NCT05655689.&amp;draw=2&amp;rank=1<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-023-06362-0","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T08:02:23Z","timestamp":1705651343000},"page":"1865-1882","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A comparison of antimicrobial regimen outcomes and antibiogram development in microbial keratitis: a prospective cohort study in Alexandria, Egypt"],"prefix":"10.1007","volume":"262","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7356-9287","authenticated-orcid":false,"given":"Amira A.","family":"Nayel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-8567","authenticated-orcid":false,"given":"Noha A.","family":"Hamdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-1664","authenticated-orcid":false,"given":"Tamer H.","family":"Massoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-5032","authenticated-orcid":false,"given":"Nelly M.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"key":"6362_CR1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.survophthal.2018.12.003","volume":"64","author":"L Ung","year":"2019","unstructured":"Ung L, Bispo PJM, Shanbhag SS et al (2019) The persistent dilemma of microbial keratitis: global burden, diagnosis, and antimicrobial resistance. 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