AzTrials
AzTrials

Bacterial KeratitisNCT05655689

The Antibiogram and Outcomes of Antimicrobial Regimens in Microbial Keratitis: A Prospective Cohort Study

An observational study of Bacterial Keratitis and Fungal Keratitis, run by Alexandria University at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This study is an observational prospective cohort study which aims to generate an antibiogram and to assess the clinical responses and outcomes of microbial keratitis patients, treated with empiric topical antimicrobial therapies, with the main objective being to recommend the most effective empiric therapy. Read more about this study

Who is it for?
Ages 1 year to 90 years
What is being tested?
Moxifloxacin Ophthalmic 0.5% Ophthalmic Solution, Ceftazidime 5% + vancomycin 5% and Gentamicin 1.4% + vancomycin 5%
How many people
123 participants
Where
1 siteEgypt
Study dates
31 Dec 2021to 1 Jan 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 90 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: Bacterial keratitis, fungal keratitis, and mixed bacterial and fungal keratitis patients attending the Cornea Outpatient Clinic at Alexandria Main University Hospital.

Who may be able to join

  • Patients diagnosed with bacterial keratitis either clinically or by culture.
  • Patients diagnosed with fungal keratitis either clinically or by culture.
  • Patients diagnosed with mixed bacterial and fungal keratitis either clinically or by culture.

Who cannot join

  • Patients diagnosed with corneal abrasions and non-infectious corneal ulcers.
  • Patients diagnosed with acanthamoeba keratitis as a single causative agent.
  • Patients diagnosed with viral keratitis as a single causative agent.
  • Patients who are noncompliant to treatment.

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • Cornea Outpatient Clinic at Alexandria Main University Hospital

    Alexandria

Other trials in Egypt

About this study

Official title: Evaluation of Antibiogram Results and Clinical Response to Prescribed Antimicrobials in Microbial Keratitis Patients

This study is an observational prospective cohort study which aims to generate an antibiogram and to assess the clinical responses and outcomes of microbial keratitis patients, treated with empiric topical antimicrobial therapies, with the main objective being to recommend the most effective empiric therapy. Microbial keratitis patients are attending the Cornea Outpatient Clinic at Alexandria Main University Hospital, Alexandria, Egypt.

Read the detailed description

The main objective of this observational study is to recommend the most effective empiric topical antimicrobial therapy in microbial keratitis, according to the current local antimicrobial resistance data and the clinical outcomes of patients with bacterial, fungal, and mixed bacterial and fungal keratitis being treated with different empiric topical antibiotics and antifungal therapies.

In the study, test results of routinely performed culture and sensitivity on corneal scraping samples and on contact lenses in indicated severe, centrally located, and large ulcers are collected and analyzed. The sensitivity data is utilized to generate an antibiogram to describe the local prevalence of bacteria and fungi causing microbial keratitis and to investigate the prevalence of antimicrobial resistance.

Results of the culture and sensitivity are often delayed, hence empiric broad- spectrum antimicrobial therapy is ideally started after corneal scraping, until laboratory test results are obtained. Broad-spectrum empiric therapy will be modified into a more selective culture- guided therapy if the causative agent and its antimicrobial sensitivity are identified.

Empiric therapy continues in cases where the culture results are negative together with clinical improvement. Also, when patients have already been on empiric treatment before presenting to the clinic, corneal scraping and culture are not performed.

In the study, microbial keratitis patients diagnosed as either bacterial, fungal, or mixed bacterial and fungal keratitis, taking the empiric topical antimicrobials, are observed. The study investigator 's role is to observe and study the clinical responses and treatment outcomes of microbial keratitis patients who are on different empiric antimicrobial therapies as part of the routine medical care. There is no assignment of any intervention to the study participants. The investigator does not intervene, and does not prescribe, recommend, or assign any intervention to the study participants.

The clinical response of microbial keratitis patients, who are on different empiric antibiotics and antifungal eye drops, is studied by determining the primary and secondary outcomes. Measured outcomes include corneal ulcer healing, time to epithelialization, improvement in visual acuity, rates of surgical interventions and complications.

Being tested
Moxifloxacin Ophthalmic 0.5% Ophthalmic Solution, Ceftazidime 5% + vancomycin 5%, Gentamicin 1.4% + vancomycin 5%, Natamycin 5% Oph Susp, Voriconazole 1%
Keywords
Microbial keratitis, Infectious corneal ulcer, Bacterial keratitis, Fungal keratitis, Mycotic keratitis, Antibiogram, Antimicrobial resistance, Culture, Sensitivity, Fortified antibiotics eye drops, Moxifloxacin, Natamycin, Voriconazole, Prevalence, Antifungal eye drops, Bacteria, Fungi, Vancomycin, Ceftazidime, Gentamicin
Medical subject headings
Hypersensitivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Moxifloxacin Ophthalmic 0.5% Ophthalmic SolutionDrug

    Also called Vigamox®

    In the observational study, patients treated with topical antibiotic moxifloxacin 0.5% eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Ceftazidime 5% + vancomycin 5%Drug

    Also called (CAZ-VAN)

    In the observational study, patients treated with topical fortified antibiotics ceftazidime 5% and vancomycin 5% eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Gentamicin 1.4% + vancomycin 5%Drug

    Also called (GEN-VAN)

    In the observational study, patients treated with the topical fortified antibiotics gentamicin 1.4% and vancomycin 5% eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Natamycin 5% Oph SuspDrug

    In the observational study, patients treated with the topical natamycin 5% antifungal eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Voriconazole 1%Drug

    Also called Vfend®

    In the observational study, patients treated with voriconazole 1% antifungal eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Natamycin 5% + voriconazole 1%Drug

    Also called (NT-VRC)

    In the observational study, patients treated with the topical natamycin 5% and voriconazole 1% antifungals eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Natamycin 5%+ ceftazidime 5% + vancomycin 5%Drug

    Also called (NT-CAZ-VAN)

    In the observational study, patients treated with the topical natamycin 5% and antifungal and the fortified antibiotic ceftazidime 5% and vancomycin 5% eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

  • Voriconazole 1% + ceftazidime 5% + vancomycin 5%Drug

    Also called (VRC-CAZ-VAN)

    In the observational study, patients treated with the topical voriconazole 1% antifungal and the fortified antibiotics ceftazidime 5% and vancomycin 5% eye drops as part of routine medical care are observed. The investigator does not assign any specific intervention to the study participants.

Study groups in NCT05655689
Study groupRoleWhat they receive
Bacterial keratitisMicrobial keratitis patients diagnosed with bacterial keratitis and treated with the empiric topical antibiotics eye drops at the usual doses for the management of bacterial keratitis, as part of routine medical care.
Receives: Drug: Moxifloxacin Ophthalmic 0.5% Ophthalmic Solution; Drug: Ceftazidime 5% + vancomycin 5%; Drug: Gentamicin 1.4% + vancomycin 5%
Fungal keratitisMicrobial keratitis patients diagnosed with fungal keratitis and treated with the empiric topical antifungals eye drops at the usual doses for the management of fungal keratitis, as part of routine medical care.
Receives: Drug: Natamycin 5% Oph Susp; Drug: Voriconazole 1%; Drug: Natamycin 5% + voriconazole 1%
Mixed bacterial and fungal keratitisMicrobial keratitis patients diagnosed with mixed bacterial and fungal keratitis and treated with the empiric topical antibiotics and antifungals eye drops at the usual doses for the management of mixed bacterial and fungal keratitis, as part of routine medical care.
Receives: Drug: Natamycin 5%+ ceftazidime 5% + vancomycin 5%; Drug: Voriconazole 1% + ceftazidime 5% + vancomycin 5%

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Corneal ulcer healing

    An ulcer is recognized as healed when there is a lack of epithelial defect, and no infiltrates. This is detected by the routine examination under the cobalt-blue light of the slit lamp biomicroscope. The absence of fluorescein staining when fluorescein is applied to the ulcer indicates an intact epithelium.

    Measured: 4 months from participation

  2. The time to epithelialization

    The time required to re-epithelialization of the corneal ulcer is measured in days.

    Measured: 4 months from participation

  3. The antibiogram generation

    The corneal scraping culture and sensitivity test results are collected to produce the local antibiogram. Antimicrobial susceptibility is determined using the standard agar disc-diffusion method (Kirby-Bauer) by measuring the zone of inhibition. For each isolate, percentage susceptibility to the antimicrobial is calculated by dividing the number of susceptible isolates by the total number of tested isolates.

    Measured: 4 months from participation

Secondary outcomes (5)
  1. The best spectacle-corrected visual acuity

    The best spectacle-corrected visual acuity (BCVA) is routinely measured using the Snellen chart. The baseline (BCVA) and the post-treatment (BCVA) are recorded as decimal values of Snellen fractions. For patients with very low vision, the semiquantitative scale of counting fingers (CF), hand motion (HM), perception of light (PL) and no perception of light (NPL) is quantified by their conversion into the equivalent decimal values using the Freiburg Visual Acuity Test (FrACT). The improvement in (BCVA) is measured by finding the difference between the post-treatment BCVA and the baseline BCVA.

    Measured: 4 months from participation

  2. Surgical interventions

    The percentage of surgical interventions is calculated. An example of surgical intervention is therapeutic penetrating keratoplasty (TKP)

    Measured: 4 months from participation

  3. Corneal perforations

    The percentage of corneal perforations is calculated. Corneal perforations are routinely tested by the Seidel test on slit lamp biomicroscope examination with cobalt blue light.

    Measured: 4 months from participation

  4. Corneal melting

    The percentage of corneal melting is calculated. Corneal melting is clinically diagnosed by the slit lamp biomicroscope examination.

    Measured: 4 months from participation

  5. Corneal opacities

    The percentage of corneal opacities is calculated. The presence of corneal opacity is detected by the slit lamp biomicroscope examination.

    Measured: 4 months from participation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Dec 2022
  2. Study start31 Dec 2021
  3. Primary completion1 Jan 2023
  4. Study completion1 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
123 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05655689
Sponsor's protocol ID
ID 0106991
Status last verified
Nov 2022
First submitted
22 Nov 2022
Last updated
25 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Nayel AA, Hamdy NA, Massoud TH, Mohamed NM. A comparison of antimicrobial regimen outcomes and antibiogram development in microbial keratitis: a prospective cohort study in Alexandria, Egypt. Graefes Arch Clin Exp Ophthalmol. 2024 Jun;262(6):1865-1882. doi: 10.1007/s00417-023-06362-0. Epub 2024 Jan 19.

    PubMed 38240778

Questions about this trial

What is this clinical trial studying?

An observational study of Bacterial Keratitis and Fungal Keratitis, run by Alexandria University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Corneal ulcer healing (time frame: 4 months from participation). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05655689, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jan 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in