To study the epidemiology and landscape of ocular infections in patients undergoing microbiological investigations across a multi-tier ophthalmology network in India.
This cross-sectional hospital-based study included 15,822 patients in whom microbiology samples were analysed between September 2013 and December 2021. Ocular tissue of patients in whom a microbiology sample was processed in at least one eye were included. The data were collected using an indigenously developed electronic medical record system.
Among the 15,822 patients, bacteria (51.06%) was the most common aetiology followed by fungus (38.27%). The majority of the patients were male (68.10%) and adults (90.01%). The most common age group was during the sixth decade of life with 2,914 (18.42%) patients. The patients were more commonly from the lower socio-economic status (51.61%) and from the rural geography (46.82%). Majority of the specimens sent for microbiological analysis were corneal scrapings (68.61%) followed by vitreous (8.77%). The most common bacteria isolated was Staphylococcus aureus (14.45%) followed by Pseudomonas aeruginosa (12.53%) and among the fungus were Fusarium (30.53%) and Aspergillus species (29.86%). Acanthamoeba (1.26%) and Microsporidia (0.38%) accounted for a minority of the infections in the samples. Fungus (53.10%; p ≤ 0.00001) and virus (51.08%; p = 0.000673) aetiology was found to be significantly higher in patients presenting from the rural geography.
The most common aetiology of infection in ocular disease is bacterial but fungal infections also accounted for a significant proportion. The majority of the patients with ocular infections presented from the rural geography and from lower socio-economic status.
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The data generated in this study is available at the following weblink – https://www.lvpei.org/aeye/microbiology.html and further clarifications are available with the corresponding author on request.
Miller D. Update on the epidemiology and antibiotic resistance of ocular infections. Middle East Afr J Ophthalmol. 2017;24:30–42.
Teweldemedhin M, Gebreyesus H, Atsbaha AH, Asgedom SW, Saravanan M. Bacterial profile of ocular infections: a systematic review. BMC Ophthalmol. 2017;17:212.
Epling J. Bacterial conjunctivitis. Clin Evid. 2012;2:704.
Joseph J, Karolia R, Sharma S, Choudhary H, Naik MN. Microbiological profile and antibiotic susceptibility trends in orbital cellulitis in India: an analysis over 15 years. Orbit 2021;23:1–7.
Das S, Samantaray R, Mallick A, Sahu SK, Sharma S. Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: a trend analysis of 8 years. Indian J Ophthalmol. 2019;67:49–53.
Joseph J, Sontam B, Guda SJM, Gandhi J, Sharma S, Tyagi M, et al. Trends in microbiological spectrum of endophthalmitis at a single tertiary care ophthalmic hospital in India: a review of 25 years. Eye. 2019;33:1090–5.
Lee S, Doktorchik C, Martin EA, D’Souza AG, Eastwood C, Shaheen AA, et al. Electronic medical record–based case phenotyping for the Charlson conditions: scoping review. JMIR Med Inf. 2021;9:e23934 https://doi.org/10.2196/23934
Adler-Milstein J, Jha AK. HITECH act drove large gains in hospital electronic health record adoption. Health Aff. 2017;36:1416–22.
Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, et al. Adoption of electronic personal health records in Canada: perceptions of stakeholders. Int J Health Policy Manag. 2016;5:425–33.
Rao GN, Khanna RC, Athota SM, Rajshekar V, Rani PK. Integrated model of primary and secondary eye care for underserved rural areas: the L V Prasad Eye Institute experience. Indian J Ophthalmol. 2012;60:396–400.
Das AV, Kammari P, Vadapalli R, Basu S. Big data and the eyeSmart electronic medical record system - an 8-year experience from a three-tier eye care network in India. Indian J Ophthalmol. 2020;68:427–32.
Ayehubizu Z, Mulu W, Biadglegne F. Common bacterial causes of external ocular infections, associated risk factors and antibiotic resistance among patients at ophthalmology unit of Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study. J Ophthal Inflamm Infect. 2021;11:7 https://doi.org/10.1186/s12348-021-00238-2
Srinivasan M, Gonzales CA, George C, Cevallos V. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol. 1997;81:965–71.
Ormerod LD, Hertzmark E, Gomez DS, Stabiner RG, Schanzlin DJ, Smith RE. Epidemiology of microbial keratitis in southern California. A multivariate analysis. Ophthalmology 1987;94:1322–33.
Sand D, She R, Shulman IA, Chen DS, Schur M, Hsu HY. Microbial keratitis in los angeles: The doheny eye institute and the los angeles county hospital experience. Ophthalmology. 2015;122:918–24.
Silvester A, Neal T, Czanner G, Briggs M, Harding S, Kaye S. Adult bacterial conjunctivitis: resistance patterns over 12 years in patients attending a large primary eye care Centre in the UK. BMJ Open Ophthalmol. 2016;11:e000006.
Bharathi MJ, Ramakrishnan R, Shivakumar C, Meenakshi R, Lionalraj D. Etiology and antibacterial susceptibility pattern of community-acquired bacterial ocular infections in a tertiary eye care hospital in South India. Indian J Ophthalmol. 2010;58:497.
The authors wish to acknowledge the Hyderabad Eye research Foundation and the support of our Department of eyeSmart EMR & AEye team specially Mr. Ranganath Vadapalli and Mr. Mohammad Pasha. Hyderabad Eye Research Foundation, Hyderabad, India.
The authors declare no competing interests.
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Das, A.V., Joseph, J. The microbiological landscape and epidemiology of ocular infections in a multi-tier ophthalmology network in India: an electronic medical record driven analytics report. Eye (2022). https://doi.org/10.1038/s41433-022-02191-3