Medical History, Clinical Features, Treatment Outcome and Its Predictors Among Infectious Keratitis Patients in Jimma University Medical Center, Southwest Ethiopia: Prospective Observational Study

Abstract

Background

Infectious keratitis is a major global cause of visual impairment and irreversible blindness among the corneal diseases. Its diagnosis and management remain getting challenge. The clinical and visual outcome remains poor in developing countries. The aim of this study was to determine treatment outcome and its predictors among patients with infectious keratitis.

Methods

Prospective observational study was conducted among adult patients diagnosed with infectious keratitis at the Ophthalmology Department in Jimma University Medical Center from April 1 to September 30, 2019. The primary outcome indicator was response of the ulcer to empirical treatment. Ulcers that did not heal and required surgery had a poor outcome. Variables with a p-value of <0.25 were entered into a multivariate logistic regression model to determine the independent predictors of poor treatment outcome and variables with a p-value of <0.05 were considered statistically significant.

Results

The research involved 131 adult patients. Eighty-seven (66.4%) were males. The mean age was 39.38 (±18.9) years. Eighty-three (63.4%) patients had poor treatment outcome. Mean length of hospital stay was 17.38 (±12.563) days. Poor visual outcome was observed among 71 (54.2%) participants. Evisceration was done for seven (5.3%) patients. Independent predictors of poor treatment outcome include perforation at admission (AOR=6.1, 95%CI: 1.5–25.1), presence of comorbidity (AOR=7.7, 95%CI: 2.16–27.3), poor adherence (AOR=5.3, 95%CI: 1.8–25.9), traditional medicine use (AOR=6.7, 95%CI: 1.8–25.4), ulcer depth >1/3 (AOR=7.6, 95%CI: 2.48–48.23) and farm workers (AOR=3.59, 95%CI: 1.09–11.77). Major complications occurred after admissions were perforation (14.5%), followed by endophthalmitis (7.63%) and corneal opacity (6.87%).

Conclusion and Recommendation

Our study found high poor treatment outcomes and high poor visual outcomes. Presence of comorbidity, perforation at admission, traditional medicine use, working on a farm, poor adherence, and ulcer depth were the predictors of poor treatment outcome. This high poor outcome requires a nationwide interventional study and urgent intervention that may reach rural communities.

Keywords:

• microbes
• infectious keratitis
• treatment outcome
• risk factors
• Ethiopia

Abbreviations

JUMCOD, Jimma University Medical Center Ophthalmology Department; PKP, penetrating keratoplasty; VA, visual acuity.

Data Sharing Statement

This article contains all the data produced or analyzed during this research. During the current analysis, the datasets used and/or analyzed are available on request from the corresponding author.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the Declaration of Helsinki. Ethical clearance and approval was obtained from Institutional Review Board of Jimma University with reference number of JHRPGD/548/2019, which was granted on April 15, 2019. For patients 15–18 years voluntarily written assents were first obtained from the patients whether they involve their parents or not then, their parents voluntarily signed informed consent forms before enrollment. However, all subjects older than 18 years voluntarily participated in our study and signed informed consent forms before enrollment.

Acknowledgments

Authors wish to thank data collectors, Morisky–Green–Levine four-item medical adherence scale creators, study participants, and Jimma University and JUMCOD staffs.

Author Contributions

All authors made a significant contribution to the reported work, whether in the conception, design of the study, execution, data acquisition, analysis and interpretation, or in all of these areas; participated in the drafting, revision or critical review of the article; gave final approval of the version to be published; agreed on the journal to which the article was submitted; and agreed to accept the drafting of the article.

Disclosure

The authors report no conflicts of interests in this work.

Additional information

Funding

This study was supported by (data collection fee) Jimma University. The funders played no role in the study.