{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:24:58Z","timestamp":1789669498525,"version":"4.0.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Infectious keratitis is a serious cause of visual impairment, particularly in low-income communities. This study examines the associations between social risk factors and polymicrobial keratitis, multidrug resistance, pathogen spectrum, and outcomes at a county hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective study of Zuckerberg San Francisco General Hospital patients treated for infectious keratitis from 2010 to 2021. Multivariable regression was performed to analyze the relationships between social, medical, and psychiatric risk factors with polymicrobial growth, multidrug resistance, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 174 patients with infectious keratitis, 44 (25%) had polymicrobial growth. Six patients (14%) with polymicrobial growth had multidrug-resistant organisms. Homeless patients were more likely to present with polymicrobial infection (odds ratio [OR] 3.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.023), and polymicrobial infections were associated with multidrug-resistant organisms (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.018). Smoking, drug use, HIV positivity, prior corneal pathology, and contact lens use were not associated with an increased risk of polymicrobial infection. Eleven patients (6.3%) were started on topical antibiotics before presentation; of these, none developed polymicrobial infections or multidrug-resistant organisms. Polymicrobial infections increased the likelihood to initiation of fortified antibiotics (OR 2.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.011) but did not impact ulcer size, final visual acuity, time to resolution, or likelihood of emergent procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Homelessness correlates with an increased risk of polymicrobial keratitis and subsequent multidrug resistance, supporting initiation of broad antibiotic coverage in this population. Prior topical antibiotics did not increase risk of polymicrobial infection. Polymicrobial infection did not significantly worsen clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/coa.0000000000000016","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T15:00:06Z","timestamp":1695308406000},"page":"e0016-6","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Characterization of Polymicrobial and Antibiotic-Resistant Infectious Keratitis in a County Hospital Setting"],"prefix":"10.1097","volume":"2","author":[{"given":"Lawrence","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline B.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murtaza","family":"Saifee","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriranjani","family":"Padmanabhan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"},{"name":"Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda F.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"},{"name":"Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; and"},{"name":"Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Yung","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California, San Francisco, San Francisco, CA;"},{"name":"Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,9]]},"reference":[{"key":"R1-20241016","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0161-6420(96)30738-0","article-title":"The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis","volume":"103","author":"McLeod","year":"1996","journal-title":"Ophthalmology"},{"key":"R2-20241016","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1001\/archophthalmol.2010.144","article-title":"Epidemiology of ulcerative keratitis in Northern California","volume":"128","author":"Jeng","year":"2010","journal-title":"Arch Ophthalmol."},{"key":"R3-20241016","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/ICO.0000000000001417","article-title":"Bacterial keratitis: isolated organisms and antibiotic resistance patterns in San Francisco","volume":"37","author":"Peng","year":"2018","journal-title":"Cornea"},{"key":"R4-20241016","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/S0161-6420(00)00179-2","article-title":"Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones","volume":"107","author":"Alexandrakis","year":"2000","journal-title":"Ophthalmology"},{"issue":"suppl 1","key":"R5-20241016","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1097\/ICL.0000000000000334","article-title":"Epidemiology and outcome of microbial keratitis: private university versus urban public hospital care","volume":"44","author":"Truong","year":"2018","journal-title":"Eye Contact Lens"},{"key":"R6-20241016","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.4103\/ijo.IJO_1821_18","article-title":"Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty","volume":"67","author":"Shah","year":"2019","journal-title":"Indian J Ophthalmol."},{"key":"R7-20241016","doi-asserted-by":"crossref","first-page":"e113843","DOI":"10.1371\/journal.pone.0113843","article-title":"A multi-center, cross-sectional study on the burden of infectious keratitis in China","volume":"9","author":"Song","year":"2014","journal-title":"PLoS One."},{"key":"R8-20241016","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1097\/00003226-199909000-00009","article-title":"Risk factors for pediatric presumed microbial keratitis: a case-control study","volume":"18","author":"Vajpayee","year":"1999","journal-title":"Cornea"},{"key":"R9-20241016","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.ajo.2015.07.028","article-title":"Comparison between polymicrobial and fungal keratitis: clinical features, risk factors, and outcome","volume":"160","author":"Fernandes","year":"2015","journal-title":"Am J Ophthalmol."},{"key":"R10-20241016","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/ICL.0000000000000022","article-title":"Triple infection keratitis","volume":"40","author":"Ray","year":"2014","journal-title":"Eye Contact Lens"},{"key":"R11-20241016","first-page":"153","article-title":"Polymicrobial keratitis","volume":"79","author":"Jones","year":"1981","journal-title":"Trans Am Ophthalmol Soc."},{"key":"R12-20241016","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/ICL.0b013e3182a3024e","article-title":"Polymicrobial versus monomicrobial keratitis: a retrospective comparative study","volume":"39","author":"Lim","year":"2013","journal-title":"Eye Contact Lens"},{"key":"R13-20241016","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1007\/s00417-020-04681-0","article-title":"Microbial keratitis in Sydney, Australia: risk factors, patient outcomes, and seasonal variation","volume":"258","author":"Khoo","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"R14-20241016","article-title":"Author response: numerical imputation for low vision states","author":"Bach","year":"2007","journal-title":"nvest Ophthalmol Vis Sci. 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