Complex Ocular Infection, Optimization of Microbiological Diagnosis

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the impact of different technique to optimize the microbiological diagnosis of the COI. Metagenomic for the endophtalmitis Multiplex polymerase chain reaction for corneal abscesses

Detailed Description
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Microbiological diagnosis of complex ocular infection (COI) (i.e: endophtalmitis and corneal abscess) is a current challenge. Indeed, endophtalmitis are often germ-free because a lack of microbiological diagnosis due to small volume to analyze and a complex site to attain. The microbiological etiologies of corneal abscesses are more frequently identified. Since few years, new molecular tools are developed in infectious diseases to optimizing the microbiological diagnosis. The investigators implemented these techniques in our hospital to optimize the microbiological diagnosis of complex ocular infection (COI). Thus, endophtalmitis benefit, when the volume of the ocular sample is sufficient, of molecular techniques (16s PCR and metagenomic shotgun). Corneal abscesses could shortly benefit of multiplex PCR in order to reduce the time to diagnosis. The impact and accuracy of these techniques is unknown.

Official Title
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Complex Ocular Infection, Optimization of Microbiological Diagnosis

Conditions
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Endophthalmitis, Keratitis

Intervention / Treatment
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* Diagnostic Test: NGS for endohtalmitis / Multiplex PCR for keratitis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patient Patient presenting or having presented a clinical suspicion of complex ocular infection requiring a sample for microbiological diagnosis: Corneal abscess requiring hospitalization Any suspicion of endogenous or exogenous endophthalmitis. Patient not opposed to participating in the research Patient affiliated with a social security scheme (excluding AME) Exclusion Criteria: Patient under guardianship or curatorship Pregnant women

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Complex ocular infections (COI)<br>All patients with an COI (endophtalmitis or hospitalized keratitis) | Diagnostic Test: NGS for endohtalmitis / Multiplex PCR for keratitis<br>* For endophtalmitis : optimizing culture and NGS will be realized For keratitis: Multiplex PCR will be added on ocular samples<br>* Other names: Bundle of intervervention to optimizing diagnosis of ocular complex infections;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Positivity rates of COI samples according to the new protocol | Before/after type comparison. Comparison of the positivity rates of COI samples according to the new protocol: (i) for endophthalmitis performing a vitreous puncture (PV) or an anterior chamber puncture (PCA) optimized with modification of microbiological techniques (culture on enriched medium alone associated with shotgun metagenomics), (ii) for severe corneal abscesses, addition to standard microbiological techniques of molecular biology tests (multiplex PCR and / or metagenomics). An COI will be considered with a positive microbiological diagnosis after multidisciplinary concertation considering the different results | 2 weeks after taking samples | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Microbiological diagnosis of the infection | Analysis of a prospective cohort of COI | At the end of the follow up: 18 months | 
| Time to microbiological diagnosis according to the different technic | Analysis of a prospective cohort of COI | At the end of the follow up: 18 months | 
| Accuracy of the different technics according to the gold standard (microbiological culture) | Analysis of a prospective cohort of COI | At the end of the follow up: 18 months | 
| Visual acuity | Evaluation of visual acuity at the end of treatment and the cure rate. The investigators hypothesized that the improvement of the microbiological diagnosis allows an improvement of the therapeutic management and thus of the visual outcome. | At the end of the follow up: 18 months | 
| Cure rate | Evaluation of visual acuity at the end of treatment and the cure rate. The investigators hypothesized that the improvement of the microbiological diagnosis allows an improvement of the therapeutic management and thus of the visual outcome. | At the end of the follow up: 18 months | 
| Modification or not of the anti-infectious treatment | Analysis of the impact of microbiological diagnosis on the choice of anti-infectious molecules.. The investigators hypothesized that the improvement of the microbiological diagnosis and the implementation of the COI management bundle will induce a modification of the prescription of anti-infectious molecules. The investigators will realize a qualitative and quantitative analysis of prescribed anti-infective molecules | At the end of the follow up: 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endogenous Endophtalmitis, exogenous endophtalmitis, keratitis, PCR, NGS