{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:36:38Z","timestamp":1791221798919,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>To determine the incidence, causative organisms, and treatment effectiveness for microbial keratitis (MK) in the Southwest of England. Retrospective analysis of 872 corneal scrapes (January 2018\u2013December 2022). Microbiology results were evaluated for organism growth and antimicrobial sensitivity. Data were divided into two groups for trend analysis (A: 2018\u20132020, B: 2021\u20132022). Of the 872 scrapes, 357 (39.6%) were culture positive. Bacteria accounted for 90.2% of cases, followed by viruses (2.8%), fungi (2.5%), mixed bacterial growth (2.5%), and Acanthamoeba (2.0%). The estimated incidence of MK was 9.69\/100,000\/year. Group B had a significantly higher overall MK incidence, with no change in pathogen distribution. Pseudomonas aeruginosa was the most frequent isolate (69 cases, 19.3%). In vitro sensitivity to fluoroquinolones was 94.4% for Gram-positive and 98.6% for Gram-negative bacteria. All fungal isolates were sensitive to at least one antifungal. Bacterial pathogens dominate MK in the Southwest of England, with over 90% sensitivity to chloramphenicol, fluoroquinolones, and aminoglycosides, indicating low antimicrobial resistance. Fluoroquinolones remain the recommended first-line therapy for MK. Fungal and protozoal keratitis are rare (&lt;3% of cases), supporting bacteria-focused empirical treatment with close monitoring.<\/jats:p>","DOI":"10.3390\/microorganisms13071578","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:20:11Z","timestamp":1751628011000},"page":"1578","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Five-Year Analysis of Microbial Keratitis Incidence, Isolates, and In Vitro Antimicrobial Sensitivity in the South West of England: An Epidemiological Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Poonam","family":"Sharma","sequence":"first","affiliation":[{"name":"West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-3578","authenticated-orcid":false,"given":"Chimwemwe","family":"Chipeta","sequence":"additional","affiliation":[{"name":"Vision and Eye Research Institute, Anglia Ruskin University, Cambridge CB1 2LZ, Cambridgeshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"O\u2019Kane","sequence":"additional","affiliation":[{"name":"Derriford Hospital, University Hospitals Plymouth NHS Foundation Trust, Plymouth PL6 8DH, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Whiteman","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryher","family":"Francis","sequence":"additional","affiliation":[{"name":"Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay TQ2 7AA, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4122-6937","authenticated-orcid":false,"given":"Richard","family":"Thornton","sequence":"additional","affiliation":[{"name":"North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple EX31 4JB, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indy","family":"Sian","sequence":"additional","affiliation":[{"name":"Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, Somerset, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Buscombe","sequence":"additional","affiliation":[{"name":"West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Court","sequence":"additional","affiliation":[{"name":"Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay TQ2 7AA, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Knox-Cartwright","sequence":"additional","affiliation":[{"name":"West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3590-0856","authenticated-orcid":false,"given":"Harry","family":"Roberts","sequence":"additional","affiliation":[{"name":"West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, Devon, UK"},{"name":"Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2HZ, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.survophthal.2018.12.003","article-title":"The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance","volume":"64","author":"Ung","year":"2019","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","first-page":"214","article-title":"Corneal blindness: A global perspective","volume":"79","author":"Whitcher","year":"2001","journal-title":"Bull. World Health Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2716","DOI":"10.1038\/s41433-023-02404-3","article-title":"Analysis of microbial keratitis incidence, isolates and in-vitro antimicrobial susceptibility in the East of England: A 6-year study","volume":"37","author":"Moledina","year":"2023","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1136\/bjophthalmol-2020-316128","article-title":"12-year analysis of incidence, microbiological profiles and in vitro antimicrobial sensitivity of infectious keratitis: The Nottingham Infectious Keratitis Study","volume":"105","author":"Ting","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1136\/bjo.2009.169607","article-title":"Geographic variations in microbial keratitis: An analysis of the peer-reviewed liter-ature","volume":"95","author":"Shah","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1136\/bjo.2008.151167","article-title":"Epidemiological characteristics, predisposing factors and microbiological profiles of infectious corneal ulcers: The Portsmouth corneal ulcer study","volume":"93","author":"Ibrahim","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1136\/bjo.87.7.834","article-title":"Bacterial keratitis: Predisposing factors, clinical and microbiological review of 300 cases","volume":"87","author":"Bourcier","year":"2003","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1038\/sj.eye.6700151","article-title":"Incidence and risk factors for microbial keratitis in Hong Kong: Comparison with Europe and North America","volume":"16","author":"Lam","year":"2002","journal-title":"Eye"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1038\/eye.2010.231","article-title":"In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: A 10-year review","volume":"25","author":"Orlans","year":"2011","journal-title":"Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/S0161-6420(99)00716-2","article-title":"Emerging fluoroquinolone resistance in bacterial keratitis: A 5-year review","volume":"106","author":"Goldstein","year":"1999","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1089\/jop.2007.0085","article-title":"Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis","volume":"24","author":"Afshari","year":"2008","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jtos.2021.08.007","article-title":"The epidemiology of infectious keratitis","volume":"28","author":"Stapleton","year":"2023","journal-title":"Ocul. Surf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/ceo.14113","article-title":"Infectious keratitis: A review","volume":"50","author":"Khoo","year":"2022","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3459","DOI":"10.1038\/s41433-024-03323-7","article-title":"Clinical features, risk factors and outcomes of contact lens-related bacterial keratitis in Nottingham, UK: A 7-year study","volume":"38","author":"Suresh","year":"2024","journal-title":"Eye"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1038\/s41433-019-0463-6","article-title":"An 11-year analysis of microbial keratitis in the South West of England using brain-heart infusion broth","volume":"33","author":"Tavassoli","year":"2019","journal-title":"Eye"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1038\/s41433-018-0085-4","article-title":"A 10-year analysis of microbiological profiles of microbial keratitis: The North East England Study","volume":"32","author":"Ting","year":"2018","journal-title":"Eye"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1038\/eye.2017.55","article-title":"Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital","volume":"31","author":"Tan","year":"2017","journal-title":"Eye"},{"key":"ref_18","unstructured":"(2025, June 01). Royal College of Pathologists. Available online: https:\/\/www.rcpath.org\/trainees\/training\/training-by-specialty.html."},{"key":"ref_19","first-page":"669","article-title":"Contact Lens-Associated Keratitis-an Often Underestimated Risk","volume":"119","author":"Maier","year":"2022","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S1367-0484(99)80003-4","article-title":"Population-based cohort study of microbial keratitis in Scotland: Incidence and features","volume":"22","author":"Seal","year":"1999","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1016\/S1473-3099(20)30448-5","article-title":"The global incidence and diagnosis of fungal keratitis","volume":"21","author":"Brown","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_22","first-page":"366","article-title":"Significance of coagulase negative Staphylococcus from blood cultures: Persisting problems and partial progress in resource constrained settings","volume":"8","author":"Sidhu","year":"2016","journal-title":"Iran. J. Microbiol."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/7\/1578\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:45Z","timestamp":1760033085000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/7\/1578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["microorganisms13071578"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13071578","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]}}}