{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T07:10:33Z","timestamp":1793776233191,"version":"4.6.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ophthal Inflamm Infect"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Microbial keratitis is a vision-threatening corneal infection frequently encountered in tertiary eye care settings. Early identification of risk factors and prompt empirical treatment are essential for preventing permanent visual impairment and maintaining anatomical integrity. This study aimed to define the clinical and microbiological profiles of microbial keratitis and to evaluate empirical treatment responses and surgical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a descriptive, retrospective study conducted through a review of clinical records over a five-year period (2020\u20132025). A total of 73 patients diagnosed with microbial keratitis at a tertiary eye care center were included. Data on demographic characteristics, predisposing risk factors, clinical presentation, microbiological culture results, and treatment modalities were collected. The patients\u2019 responses to empirical medical therapy and the need for surgical interventions, including penetrating keratoplasty, pars plana vitrectomy and evisceration were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Positive microbial cultures were obtained in 58.9% of the cases. Among these,\n                      <jats:italic>Staphylococcus spp.<\/jats:italic>\n                      was the most commonly isolated organism (36.9%), followed by\n                      <jats:italic>Streptococcus spp.<\/jats:italic>\n                      (21.7%),\n                      <jats:italic>Klebsiella spp.<\/jats:italic>\n                      (11.0%),\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      (9.0%) and fungal pathogens (4.3%). Trauma was identified as the most frequent predisposing risk factor across all age groups. Clinical improvement was observed in 65.8% of patients following topical empirical therapy. Surgical intervention was required in 25 patients due to clinical deterioration, including penetrating keratoplasty, re-keratoplasty, pars plana vitrectomy and evisceration. Endophthalmitis developed in 7 patients (9.5%) with causative organisms including\n                      <jats:italic>Staphylococcus<\/jats:italic>\n                      (44.4%),\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      (33.3%),\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      (11.1%) and\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      (11.1%). The anatomical success rate following treatment was 85.7%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Initiation of empirical therapy targeting regionally prevalent pathogens may may contribute to better visual outcomes in selected cases. In cases unresponsive to medical management, early intervention with penetrating keratoplasty prior to limbal involvement or corneal perforation may improve prognosis and reduce the incidence of severe complications such as endophthalmitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12348-025-00524-3","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:19:40Z","timestamp":1767053980000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From pathogen to prognosis: microbial keratitis spectrum and treatment outcomes in a 5-Year tertiary center experience"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3108-6295","authenticated-orcid":false,"given":"Bagim Aycin Cakir","family":"Ince","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2843-0355","authenticated-orcid":false,"given":"Onder","family":"Ayyildiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0943-8917","authenticated-orcid":false,"given":"Gokhan","family":"Ozge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"issue":"3","key":"524_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, Gilmore MS, Chodosh J (2019) The persistent dilemma of microbial keratitis: global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 64(3):255\u2013271. https:\/\/doi.org\/10.1016\/j.survophthal.2018.12.003","journal-title":"Surv Ophthalmol"},{"issue":"8","key":"524_CR2","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1007\/s00417-020-04681-0","volume":"258","author":"P Khoo","year":"2020","unstructured":"Khoo P, Cabrera-Aguas MP, Nguyen V, Lahra MM, Watson SL (2020) Microbial keratitis in sydney, australia: risk factors, patient outcomes, and seasonal variation. Graefes Arch Clin Exp Ophthalmol 258(8):1745\u20131750. https:\/\/doi.org\/10.1007\/s00417-020-04681-0","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"524_CR3","doi-asserted-by":"publisher","unstructured":"K. Schulze-Bonsel, N. Feltgen, H. Burau, L. Hansen, M. Bach (2006) Visual acuities \u2018hand motion\u2019 and \u2018counting fingers\u2019 can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis Sci. 479(3)1236\u20131240. https:\/\/doi.org\/10.1167\/IOVS.05-0981","DOI":"10.1167\/IOVS.05-0981"},{"issue":"1","key":"524_CR4","doi-asserted-by":"publisher","first-page":"P1","DOI":"10.1016\/j.ophtha.2018.10.018","volume":"126","author":"A Lin","year":"2019","unstructured":"Lin A, Rhee MK, Akpek EK et al (2019) Bacterial keratitis preferred practice pattern\u00ae. Ophthalmology 126(1):P1\u2013P55. https:\/\/doi.org\/10.1016\/j.ophtha.2018.10.018","journal-title":"Ophthalmology"},{"key":"524_CR5","unstructured":"Wilhelmus K, Liesegang T, Osato M, Jones D Laboratory diagnosis of ocular infections. Published online. 1994."},{"issue":"3","key":"524_CR6","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1097\/ICO.0b013e31815ca0bb","volume":"27","author":"T Sirikul","year":"2008","unstructured":"Sirikul T, Prabriputaloong T, Smathivat A, Chuck RS, Vongthongsri A (2008) Predisposing factors and etiologic diagnosis of ulcerative keratitis. Cornea 27(3):283\u2013287. https:\/\/doi.org\/10.1097\/ICO.0b013e31815ca0bb","journal-title":"Cornea"},{"issue":"3","key":"524_CR7","doi-asserted-by":"publisher","first-page":"e0016","DOI":"10.1097\/COA.0000000000000016","volume":"2","author":"L Chan","year":"2023","unstructured":"Chan L, Lopez JB, Saifee M, Padmanabhan S, Chan MF, Yung M (2023) Characterization of polymicrobial and antibiotic-resistant infectious keratitis in a County hospital setting. Cornea Open 2(3):e0016\u2013e0016. https:\/\/doi.org\/10.1097\/COA.0000000000000016","journal-title":"Cornea Open"},{"issue":"3","key":"524_CR8","first-page":"155","volume":"37","author":"BA Budak","year":"2011","unstructured":"Budak BA, Baykara M, T\u00fcr\u00fcd\u00fc S et al (2011) The analysis of the hospitalized cases of keratitis in our clinic. Uludag Univ Med J 37(3):155\u2013157","journal-title":"Uludag Univ Med J"},{"issue":"266","key":"524_CR9","doi-asserted-by":"publisher","first-page":"775","DOI":"10.31729\/jnma.8285","volume":"61","author":"LS Joshi","year":"2023","unstructured":"Joshi LS, Kaiti R, Shyangbo R, Bogati B (2023) Positive microbiological culture among patients with infective keratitis visiting the cornea unit of a tertiary care centre. J Nepal Med Assoc 61(266):775\u2013778. https:\/\/doi.org\/10.31729\/jnma.8285","journal-title":"J Nepal Med Assoc"},{"key":"524_CR10","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.ajo.2018.07.040","volume":"195","author":"WB Khor","year":"2018","unstructured":"Khor WB, Prajna VN, Garg P et al (2018) The Asia Cornea Society infectious keratitis study: a prospective multicenter study of infectious keratitis in Asia. Am J Ophthalmol 195:161\u2013170. https:\/\/doi.org\/10.1016\/j.ajo.2018.07.040","journal-title":"Am J Ophthalmol"},{"issue":"8","key":"524_CR11","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1038\/eye.2017.55","volume":"31","author":"SZ Tan","year":"2017","unstructured":"Tan SZ, Walkden A, Au L et al (2017) Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital. Eye (Lond) 31(8):1229\u20131236. https:\/\/doi.org\/10.1038\/eye.2017.55","journal-title":"Eye (Lond)"},{"issue":"4","key":"524_CR12","doi-asserted-by":"publisher","first-page":"700","DOI":"10.18240\/ijo.2025.04.14","volume":"17","author":"L Zhang","year":"2025","unstructured":"Zhang L, You HZ, Wang GH et al (2025) Distribution of pathogenic bacteria and antimicrobial sensitivity of eye infections in Suzhou. Int J Ophthalmol 17(4):700\u2013706. https:\/\/doi.org\/10.18240\/ijo.2025.04.14","journal-title":"Int J Ophthalmol"},{"issue":"1","key":"524_CR13","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1177\/11206721221106139","volume":"33","author":"F D\u2019Oria","year":"2023","unstructured":"D\u2019Oria F, Buonamassa R, Rizzo T et al (2023) Bacterial isolates and antimicrobial susceptibility pattern of ocular infection at a tertiary referral hospital in the South of Italy. Eur J Ophthalmol 33(1):370\u2013376. https:\/\/doi.org\/10.1177\/11206721221106139","journal-title":"Eur J Ophthalmol"},{"issue":"10","key":"524_CR14","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1038\/s41433-019-0463-6","volume":"33","author":"S Tavassoli","year":"2019","unstructured":"Tavassoli S, Nayar G, Darcy K et al (2019) An 11-year analysis of microbial keratitis in the South West of England using brain-heart infusion broth. Eye (Lond) 33(10):1619\u20131625. https:\/\/doi.org\/10.1038\/s41433-019-0463-6","journal-title":"Eye (Lond)"},{"issue":"1","key":"524_CR15","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/ICO.0000000000001417","volume":"37","author":"MY Peng","year":"2018","unstructured":"Peng MY, Cevallos V, McLeod SD, Lietman TM, Rose-Nussbaumer J (2018) Bacterial keratitis: isolated organisms and antibiotic resistance patterns in San Francisco. Cornea 37(1):84\u201387. https:\/\/doi.org\/10.1097\/ICO.0000000000001417","journal-title":"Cornea"},{"issue":"4","key":"524_CR16","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1038\/eye.2010.231","volume":"25","author":"HO Orlans","year":"2011","unstructured":"Orlans HO, Hornby SJ, Bowler ICJW (2011) In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye (Lond) 25(4):489\u2013493. https:\/\/doi.org\/10.1038\/eye.2010.231","journal-title":"Eye (Lond)"},{"issue":"1","key":"524_CR17","doi-asserted-by":"publisher","first-page":"204","DOI":"10.12182\/20250160103","volume":"55","author":"D Zhou","year":"2025","unstructured":"Zhou D, Wang Y, Deng J, Xiao Y, Xie Y (2025) Distribution and antibiotic resistance analysis of ocular bacterial pathogens at a tertiary hospital from 2012 to 2021. Sichuan Da Xue Xue Bao Yi Xue Ban 55(1):204\u2013209. https:\/\/doi.org\/10.12182\/20250160103","journal-title":"Sichuan Da Xue Xue Bao Yi Xue Ban"},{"key":"524_CR18","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.2147\/IDR.S206831","volume":"12","author":"L Lin","year":"2019","unstructured":"Lin L, Duan F, Yang Y et al (2019) Nine-year analysis of isolated pathogens and antibiotic susceptibilities of microbial keratitis from a large referral eye center in Southern China. Infect Drug Resist 12:1295\u20131302. https:\/\/doi.org\/10.2147\/IDR.S206831","journal-title":"Infect Drug Resist"},{"issue":"3","key":"524_CR19","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1016\/j.ophtha.2003.06.003","volume":"111","author":"AL Young","year":"2004","unstructured":"Young AL, Leung ATS, Cheng LL et al (2004) Orthokeratology lens-related corneal ulcers in children: a case series. Ophthalmology 111(3):590\u2013595. https:\/\/doi.org\/10.1016\/j.ophtha.2003.06.003","journal-title":"Ophthalmology"},{"issue":"4","key":"524_CR20","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1097\/ICL.0b013e3181e3ef45","volume":"36","author":"HY Hsu","year":"2010","unstructured":"Hsu HY, Nacke R, Song JC et al (2010) Community opinions in the management of corneal ulcers and ophthalmic antibiotics: a survey of 4 States. Eye Contact Lens 36(4):195\u2013200. https:\/\/doi.org\/10.1097\/ICL.0b013e3181e3ef45","journal-title":"Eye Contact Lens"},{"issue":"9","key":"524_CR21","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/j.ophtha.2006.12.011","volume":"114","author":"M Constantinou","year":"2007","unstructured":"Constantinou M, Daniell M, Snibson GR et al (2007) Clinical efficacy of Moxifloxacin in the treatment of bacterial keratitis: a randomized clinical trial. Ophthalmology 114(9):1622\u20131629. https:\/\/doi.org\/10.1016\/j.ophtha.2006.12.011","journal-title":"Ophthalmology"},{"issue":"7","key":"524_CR22","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1097\/ICO.0b013e3181ca2ba3","volume":"29","author":"VM Shah","year":"2010","unstructured":"Shah VM, Tandon R, Satpathy G et al (2010) Randomized clinical study for comparative evaluation of fourth-generation fluoroquinolones with the combination of fortified antibiotics in the treatment of bacterial corneal ulcers. Cornea 29(7):751\u2013757. https:\/\/doi.org\/10.1097\/ICO.0b013e3181ca2ba3","journal-title":"Cornea"},{"issue":"6","key":"524_CR23","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1016\/j.ophtha.2012.11.013","volume":"120","author":"N Sharma","year":"2013","unstructured":"Sharma N, Goel M, Bansal S et al (2013) Evaluation of Moxifloxacin 0.5% in treatment of nonperforated bacterial corneal ulcers: a randomized controlled trial. Ophthalmology 120(6):1173\u20131178. https:\/\/doi.org\/10.1016\/j.ophtha.2012.11.013","journal-title":"Ophthalmology"},{"issue":"4","key":"524_CR24","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/j.ajo.2003.11.010","volume":"137","author":"WL Chen","year":"2004","unstructured":"Chen WL, Wu CY, Hu FR, Wang IJ (2004) Therapeutic penetrating keratoplasty for microbial keratitis in Taiwan from 1987 to 2001. Am J Ophthalmol 137(4):736\u2013743.\u00a0https:\/\/doi.org\/10.1016\/j.ajo.2003.11.010","journal-title":"Am J Ophthalmol"},{"issue":"9","key":"524_CR25","doi-asserted-by":"publisher","first-page":"3171","DOI":"10.4103\/IJO.IJO_1344_23","volume":"71","author":"JS Christy","year":"2023","unstructured":"Christy JS, Mathews P, Ravisankar R, Akpek EK (2023) Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India. Indian J Ophthalmol 71(9):3171\u20133177. https:\/\/doi.org\/10.4103\/IJO.IJO_1344_23","journal-title":"Indian J Ophthalmol"},{"issue":"6","key":"524_CR26","doi-asserted-by":"publisher","first-page":"324","DOI":"10.4274\/TJO.GALENOS.2020.35305","volume":"50","author":"G G\u00fcm\u00fc\u015f","year":"2020","unstructured":"G\u00fcm\u00fc\u015f G, K\u0131rg\u0131z A, Y\u0131ld\u0131r\u0131m Y et al (2020) Prognostic factors affecting graft survival in patients undergoing penetrating keratoplasty for infectious keratitis. Turk J Ophthalmol 50(6):324. https:\/\/doi.org\/10.4274\/TJO.GALENOS.2020.35305","journal-title":"Turk J Ophthalmol"},{"issue":"4","key":"524_CR27","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3928\/1542-8877-20050701-09","volume":"36","author":"J Sukhija","year":"2005","unstructured":"Sukhija J, Jain AK (2005) Outcome of therapeutic penetrating keratoplasty in infectious keratitis. Ophthalmic Surg Lasers Imaging 36(4):303\u2013309. https:\/\/doi.org\/10.3928\/1542-8877-20050701-09","journal-title":"Ophthalmic Surg Lasers Imaging"},{"issue":"9","key":"524_CR28","doi-asserted-by":"publisher","first-page":"e45433","DOI":"10.7759\/cureus.45433","volume":"15","author":"AM Hadlaq","year":"2023","unstructured":"Hadlaq AM, Al Harbi MM (2023) The epidemiological profile and predisposing factors of microbial keratitis over a 10-year period at a tertiary hospital in central Saudi Arabia. Cureus 15(9):e45433. https:\/\/doi.org\/10.7759\/cureus.45433","journal-title":"Cureus"},{"key":"524_CR29","doi-asserted-by":"publisher","unstructured":"Zapata Cuevas MA, Garc\u00eda de Oteyza G, Alvarado-Villacorta R et al (2023) Pars plana vitrectomy and therapeutic keratoplasty in endophthalmitis and infectious keratitis. Eur J Ophthalmol 33(1):207\u2013215.\u00a0https:\/\/doi.org\/10.1177\/11206721221118151","DOI":"10.1177\/11206721221118151"}],"container-title":["Journal of Ophthalmic Inflammation and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-025-00524-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12348-025-00524-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-025-00524-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:19:42Z","timestamp":1767053982000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12348-025-00524-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["524"],"URL":"https:\/\/doi.org\/10.1186\/s12348-025-00524-3","relation":{},"ISSN":["1869-5760"],"issn-type":[{"value":"1869-5760","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]},"assertion":[{"value":"24 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"No funding was received for this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Not applicable. This manuscript does not contain any individual person\u2019s data (including individual details, images, or videos).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"This study was approved by the Ethics Committee of G\u00fclhane Training and Research Hospital, Ankara, T\u00fcrkiye (Approval date: 14 June 2021, Reference number: E-50687469-799). Since no personal or identifiable patient data were used, informed consent to participate was not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}}],"article-number":"99"}}