Received: 7 December 2018 

|  Revised: 5 April 2019 

|  Accepted: 18 June 2019

DOI: 10.1111/vop.12693

ORIGINAL ARTICLE

Feline bacterial keratitis: Clinical features, bacterial isolates, and

in vitro antimicrobial susceptibility patterns

Jennifer E. Goldreich  | Rebecca J. Franklin‐Guild  | Eric C. Ledbetter

Department of Clinical Sciences, College

of Veterinary Medicine, Cornell University,
Ithaca, NY
Correspondence
Eric C. Ledbetter, College of Veterinary
Medicine, Hospital for Animals, Cornell
University, VMC Box 34, Ithaca, NY
14853‐6401.
Email: ecl32@cornell.edu
Abstract
Objective: To describe clinical characteristics, bacterial isolates, and in vitro antimi-
crobial susceptibility patterns for cats with bacterial keratitis.
Animals Studied: Eighty one cats with bacterial keratitis.
Procedures: Medical records of cats with a clinical diagnosis of bacterial keratitis,
confirmed by corneal culture, were reviewed from June 2004 to July 2017. Animal
signalment, bacterial isolates, aerobic bacteria in vitro antimicrobial susceptibility
test results, and pertinent clinical features were recorded. Percentages of susceptible
aerobic bacterial isolates were statistically compared among selected antimicrobials.
Results: There were 102 aerobic bacterial isolates recovered from corneal samples
of the 81 cats presented with bacterial keratitis. The most frequent bacteria isolated
were Staphylococcus species, which constituted 55% (56/102) of total isolates. All
aerobic bacterial isolates grouped together had the highest percentage of susceptibility
to ofloxacin (100%), ciprofloxacin (94%), chloramphenicol (93%), doxycycline (92%),
ticarcillin (90%), gentamicin (89%), moxifloxacin (89%), tobramycin (86%), neomycin
(85%), amikacin (84%), and cefazolin (84%). The same isolates had the lowest percent-
age of susceptibility to polymyxin B (2%), bacitracin (15%), and clindamycin (31%).
When analyzed separately, the isolated Staphylococcus species had the highest per-
centage of susceptibility to ofloxacin (100%), tobramycin (93%), and neomycin (85%)
and the lowest percentage of susceptibility to polymyxin B (3%) and bacitracin (13%).
Conclusions: Members of the Staphylococcus genus were the most frequent bacteria
isolated from cases of feline bacterial keratitis. On the basis of in vitro susceptibility
testing and mechanism of action, ofloxacin, ciprofloxacin, ticarcillin, gentamicin, or
moxifloxacin are recommended for initial antimicrobial therapy of suspected bacte-
rial keratitis in cats.

KEYWORDS
bacteria, cornea, feline, keratitis, ulcer

1  |   IN T RO D U C T ION many other domestic animal species.1-11 Despite this, bacte-

rial keratitis is a clinically important ocular disease of cats that
Based upon the frequency of peer‐reviewed publications de- can be both vision and globe‐threatening if not treated appro-
scribing the condition, bacterial keratitis appears to be a rel- priately.12 Bacterial keratitis is often diagnosed presumptively
atively uncommon disease in domestic cats compared with and treated with empirical antimicrobial therapy, yet there are

Veterinary Ophthalmology. 2019;00:1–7. wileyonlinelibrary.com/journal/vop © 2019 American College of Veterinary     1 |

Ophthalmologists
 |
2       GOLDREICH et al
limited publications describing bacterial isolates and in vitro
antimicrobial susceptibility patterns for this condition in cats
specifically in which to base these clinical decisions.1
The objectives of the retrospective study reported here
were to determine the most common bacterial isolates and
their in vitro antimicrobial susceptibility patterns to assist in
establishing appropriate empiric antimicrobial treatment for
cats with bacterial keratitis. In addition, clinical characteris-
tics and the frequency and types of concurrent ocular infec-
tions in cats with bacterial keratitis were evaluated.
2  |  M AT E R IA L S A N D ME T HODS
2.1  |  Medical records review
Medical records of cats with a clinical diagnosis of bacterial
keratitis, confirmed by positive corneal bacterial culture re-
sults, evaluated by the ophthalmology service at the Cornell
University Hospital for Animals between June 1, 2004 and July
31, 2017, were reviewed. Animal signalment, past pertinent
medical history, clinical findings, medical therapies admin-
istered, surgeries performed, duration of treatment, treatment
response, clinical outcome, bacterial isolates, aerobic bacte-
rial in vitro antimicrobial susceptibility test results and other
microbiologic test results were recorded. Cats were included
in the study whether they had a clinical diagnosis of bacterial
keratitis, and antimicrobial susceptibility determinations were
completed with the results available in the record.13,14
2.2  | Microbiology
Corneal samples for aerobic bacterial microbiologic assess-
ment were obtained from cats through direct sampling of
the cornea using scrapings or swabs. Matrix‐Assisted Laser
Desorption/Ionization Time‐of‐Flight mass‐spectrometry
(MALDI‐TOF) or an automated system (Sensititre, Trek
Diagnostic Systems Inc) were employed for bacteriological
identifications (New York State Animal Health Diagnostic
Center). Automated bacterial identifications were supple-
mented with bacterial phenotypic classification tests and RT‐
PCR speciation to confirm identifications when necessary.
Minimum inhibitory concentration (MIC) susceptibility test-
ing was performed using an automated broth microdilution
system (Sensititre, Trek Diagnostic Systems Inc). Bacterial
isolates were tested against a panel of antimicrobials with
MIC break points set for each drug using Clinical and
Laboratory Standard Institute guidelines when available.
2.3  |  Statistical analysis
Percentages of susceptible aerobic bacterial isolates were
statistically compared among selected antimicrobials for all
bacterial isolates grouped together and for Staphylococcus
isolates grouped separately. The percentage of susceptible
isolates was compared among the individual antimicrobi-
als by use of Fisher's exact test. The P values were adjusted
for multiple comparisons by use of the Bonferroni correc-
tion, and a P ≤ 0.005 was considered significant for all com-
parisons. For the statistical analyses and reporting of results,
bacterial isolates scored as intermediate susceptibility were
included in the resistant category.
3  |  RESULTS
Eighty‐one cats with culture confirmed bacterial keratitis
were identified during the study period with in vitro antimi-
crobial susceptibility test results. The mean age (± stand-
ard deviation) of the cats in the study population was 92
(± 63) months. The study population included 43 castrated
males, five intact males, 29 spayed females, and four intact
females. Breed distribution was as follows: domestic short-
hair or domestic longhair (n = 58 cats), Persian (n = 14),
Himalayan (n  =  5), Burmese (n  =  2), Tonkinese (n  =  1),
and Bombay (n = 1). All cats had unilateral corneal lesions.
Clients most often cited ocular discharge (n  =  22 cli-
ents) and blepharospasm (n = 17) as their main complaints
prompting medical evaluation. The clinical corneal lesions
diagnosed in association with bacterial keratitis were anterior
stromal corneal ulcer (n = 22 cats), corneal sequestrum with
surrounding abscessation (n = 16), deep stromal corneal ulcer
(n = 9), corneal laceration (n = 9), descemetocele (n = 7),
corneal perforation (n = 7), corneal abscess (n = 5), kerato-
malacia (n = 4), and corneal foreign body (n = 2) (Figure 1).
In total, 102 aerobic bacteria were isolated from corneal
samples of the 81 cats with bacterial keratitis (Table 1).
(A) (B)
(C) (D)
F I G U R E 1   Clinical photographs of study cats with bacterial
keratitis, including anterior stromal corneal ulcers (A, C), deep corneal
ulcer (B), and descemetocele (D)
GOLDREICH et al
T A B L E 1   Distribution of aerobic bacteria isolates from 81 cats
with bacterial keratitis
Bacteria
Staphylococcus spp.
Staphylococcus spp. (nonspeciated)
Staphylococcus epidermidis
Staphylococcus aureus
Staphylococcus felis
Staphylococcus pseudintermedius
Staphylococcus warneri
Staphylococcus pseudintermedius
Staphylococcus capitis
Staphylococcus hominis
Staphylococcus hyicus
Staphylococcus pettenkoferi
Staphylococcus sciuri
Pasteurella spp.
Pasteurella spp. (nonspeciated)
Pasteurella multocida
Pasteurella stomatis
Bacillus spp.
Bacillus spp. (nonspeciated)
Bacillus cereus
Bacillus licheniformis
Bacillus pumilus
Streptococcus spp.
Streptococcus spp. (nonspeciated)
Streptococcus thermophilus
Enterococcus spp.
Enterococcus spp. (nonspeciated)
Enterococcus faecalis
Pseudomonas spp.
Pseudomonas spp. (nonspeciated)
Pseudomonas aeruginosa
Corynebacterium spp.
Corynebacterium spp. (nonspeciated)
Corynebacterium felinum
Achromobacter spp. (nonspeciated)
Escherichia coli
Macrococcus spp. (nonspeciated)
Pantoea spp. (nonspeciated)
Proteus spp. (nonspeciated)
Psychrobacter spp. (nonspeciated)
Sphingobacterium spp. (nonspeciated)
Single bacterial isolates were obtained from the corneal sam-
ples of 62 cats, two isolates from 17 cats, and three isolates
from two cats. Of the 102 aerobic bacteria isolated, 82 were
  
   3
|
gram‐positive and 20 were gram‐negative (Table 1). The
most frequent bacterial genera isolated were Staphylococcus
Number of isolates
spp. (n  =  56 isolates), Pasteurella spp. (n  =  10), Bacillus
spp. (n = 9), Streptococcus spp. (n = 8), Enterococcus spp.
(56)
(n  =  6), and Pseudomonas spp. (n  =  4). Aerobic bacterial
23 isolates grouped as a whole had the highest percentage of
9 susceptibility to ofloxacin (100%), ciprofloxacin (94%),
4 chloramphenicol (93%), doxycycline (92%), ticarcillin
4 (90%), tobramycin (86%), neomycin (85%), amikacin (84%),
4 and cefazolin (84%) (Tables 2-4). Grouped aerobic bacterial
4 isolates had the lowest percentage of susceptibility to poly-
3 myxin B (2%), bacitracin (15%), and clindamycin (31%)
(Table 2). The percentage of isolates susceptible to ofloxacin,
1
ciprofloxacin, chloramphenicol, doxycycline, and ticarcillin
1
was significantly (P < 0.005) greater than polymyxin B, baci-
1
tracin, and clindamycin. One Pseudomonas sp isolate was too
1 fastidious for antimicrobial susceptibility testing.
1 When evaluated separately as a group, the Staphylococcus
(10) spp. isolated had the highest percentage of susceptibility
1 to ofloxacin (100%), tobramycin (93%), neomycin (93%),
8 ciprofloxacin (91%), and gentamicin (91%) (Table 3).
1 Staphylococcus spp. had the lowest percentage of susceptibil-
(9)
ity to polymyxin B (3%), and bacitracin (13%) (Table 2). The
percentage of isolates susceptible to ofloxacin, tobramycin,
4
neomycin, ciprofloxacin, and gentamicin was significantly
3
(P < 0.005) greater than polymyxin B. The percentage of iso-
1 lates susceptible to ofloxacin, tobramycin, neomycin, cipro-
1 floxacin, and gentamicin was also significantly (P < 0.005)
(8) greater than bacitracin.
7 In addition to aerobic bacteria, 15 cats had one or more
1 concurrent infectious agents detected in ocular samples
(6) from the eye with bacterial keratitis, including viruses, an-
1
aerobic bacteria, Mycoplasma spp., and Chlamydia spp..
Virus isolation was performed in 17 cases, yielding five
5
positive results (29% positive where this assay was per-
(4)
formed): feline herpesvirus‐1 was isolated from two cats,
2
feline syncytial virus from two cats, and feline calicivirus
2 from one cat. Anaerobic bacteria were cultured from 6 out of
(2) 48 cats (13%) where this assay was performed and included
1 Bacteroides vulgatus (n = 4 isolates), Fusobacterium spp.
1 (n = 2), Actinomyces spp.(n = 1), Clostridium perfringens
1 (n = 1), Peptostreptococcus sp (n = 1), Porphyromonas levii
1 (n = 1), and Propionibacterium acnes (n = 1). Additionally,
1
4 out of 13 cats (30%) cultured positive for Mycoplasma
spp. when tested. In total, 16 PCR assays for various in-
1
fectious agents were performed on ocular samples. Feline
1
herpesvirus‐1 RT‐PCR was positive in 0 out of 4 tested cats
1 and Chlamydia felis PCR was positive in 1 of 12 tested cats.
1 Of the 81 cats with bacterial keratitis evaluated in this study,
successful treatment with both vision and globe retention oc-
curred in 71 (88%) of the cats. Seven cats were enucleated
due to complications associated with the corneal lesion (most
frequently corneal perforation), and three cats lost vision, but
 |
4       GOLDREICH et al

T A B L E 2   Antimicrobials with the

Polymyxin B Bacitracin Clindamycin
lowest percentage of susceptibly for feline
Staphylococcus spp. 3% (1/29) 13% (7/55) 35% (7/20) bacterial keratitis isolates
Bacillus spp. 0% (0/4) 0% (0/8) 0% (0/1)
Pasteurella spp. n/a 0% (0/7) 0% (0/3)
Streptococcus spp. 0% (0/4) 57% (4/7) n/a
Enterococcus spp. 0% (0/3) 17% (1/6) n/a
Pseudomonas spp. 0% (0/1) 0% (0/2) n/a
Corynebacterium spp. n/a 50% (1/2) 0% (0/1)
Achromobacter spp. 0% (0/1) 0% (0/1) n/a
Escherichia coli n/a 0% (0/1) n/a
Macrococcus spp. n/a 100% (1/1) 100% (1/1)
Pantoea spp. n/a 0% (0/1) n/a
Proteus spp. n/a 0% (0/1) n/a
Psychrobacter spp. n/a 0% (0/1) n/a
Sphingobacterium spp. 0% (0/1) 0% (0/1) n/a
Total Susceptibility 2% (1/43) 15% (14/94) 31% (8/26)
Note: Data presented as percentage susceptible (number of bacterial isolates susceptible/number of bacterial
isolates tested). Not all isolates were tested against every antimicrobial.

T A B L E 3   Antimicrobials with the highest percentage of susceptibility for gram‐positive feline bacterial keratitis isolates

Staphylococcus Bacillus Streptococcus Enterococcus Corynebacterium Macrococcus Total

Ofloxacin 100% (8/8) 100% (3/3) 100% (1/1) n/a n/a 100% (1/1) 100% (13/13)
Ciprofloxacin 91% (50/55) 100% (8/8) 100% (7/7) 100% (6/6) 100% (2/2) n/a 94% (73/78)
Chloramphenicol 85% (23/27) 100% (8/8) 100% (3/3) 100% (4/4) 100% (2/2) 100% (1/1) 91% (41/45)
Doxycycline 86% (18/21) 100% (4/4) 100% (2/2) n/a 100% (2/2) 100% (1/1) 90% (27/30)
Moxifloxacin 88% (7/8) n/a n/a n/a n/a 100% (1/1) 89% (8/9)
Ticarcillin 86% (48/56) 89% (8/9) 100% (8/8) 83% (5/6) 100% (2/2) 100% (1/1) 88% (72/82)
Gentamicin 91% (51/56) 89% (8/9) 100% (8/8) 33% (2/6) 100% (2/2) 100% (1/1) 88% (72/82)
Tobramycin 93% (51/55) 100% (7/7) 83% (5/6) 29% (2/7) 100% (2/2) 100% (1/1) 87% (68/78)
Amikacin 89.0% (49/55) 100% (9/9) 78% (7/9) 17% (1/6) 100% (2/2) 100% (1/1) 84% (69/82)
Cefazolin 76% (16/21) 100% (4/4) 100% (2/2) n/a 100% (2/2) 100% (1/1) 83% (25/30)
Neomycin 93% (51/55) 88% (7/8) 71% (5/7) 0% (0/6) 100% (2/2) 100% (1/1) 66% (56/79)
Note: Data presented as percentage susceptible (number of bacterial isolates susceptible/number of bacterial isolates tested). Not all isolates were tested against every
antimicrobial.

retained their globe. Of the 74 cats that retained their globe,
medical therapy alone was performed in 58 cats. The mean (±
standard deviation) treatment duration for cats receiving medi-
cal therapy alone was 37 (± 24) days. Surgical procedures were
performed in 16 cats to aid in the resolution of bacterial keratitis
including conjunctival pedicle graft (n = 9 cats), anterior lamel-
lar keratectomy (n = 6), and penetrating keratoplasty (n = 1).
4  |   D IS C U SS ION
In vitro susceptibility testing of microorganisms attempts to
predict the in vivo efficacy of antimicrobials ideally using
Clinical and Laboratory Standard Institute guidelines. These
laboratory standards are based on the anticipated serum drug
concentrations that are reached after administration of a spe-
cific antimicrobial.15 Currently, no separate standards are avail-
able to guide topical ophthalmic antimicrobial treatment. The
serum standards are frequently used to interpret susceptibility
of bacteria to topical ophthalmic antimicrobials; however, it is
commonly assumed that corneal tissue concentrations of anti-
microbials will be equal to or greater than serum concentrations
with topical application.15 Consequently, in vitro resistance of
bacteria to an antimicrobial may overcome in some situations
by the high corneal drug concentrations achieved with topical
therapy. As a result of this, in vitro susceptibility testing for
corneal isolates may underestimate the percentage of bacteria
susceptible to a given drug in vivo when treated topically.16
GOLDREICH et al   
   5
|
These concepts are clinically relevant when applying results

100% (11/11)

100% (18/18)
of the present study to both systemic and topical ophthalmic

94% (15/16)
94% (15/16)
93% (14/15)

81% (13/16)
80% (12/15)
100% (4/4)

100% (8/8)

88% (7/8)
antimicrobial therapy of cats with bacterial keratitis.

Total
In this study, members of the Staphylococcus genus
were the most frequent corneal isolates in cats with bacte-
rial keratitis. On the basis of in vitro susceptibility testing
of aerobic bacterial isolates and bactericidal mechanism of
Sphingobacterium

action, ofloxacin, ciprofloxacin, ticarcillin, gentamicin, or

100% (1/1) moxifloxacin are recommended for initial topical antimicro-
100% (1/1)
100% (1/1)
100% (1/1)

0% (0/1)
0% (0/1)
bial therapy of suspected bacterial keratitis in cats.17,18 While
chloramphenicol and doxycycline were effective in vitro,
n/a
n/a
n/a

n/a
they are not recommended as a first line of therapy due to
their bacteriostatic activity.17 These recommendations do not
Psychrobacter

Data presented as percentage susceptible (number of bacterial isolates susceptible/number of bacterial isolates tested). Not all isolates were tested against every antimicrobial.
replace culture and antimicrobial susceptibility determina-
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
tions when bacterial keratitis is suspected, but can help guide
therapeutic decisions while awaiting diagnostic test results or
n/a

in select cases where culture cannot be performed.

Any pathological process that disrupts normal corneal
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)

100% (1/1)

physiology, anatomy, or immunity can potentially lead to in-

Proteus

fection, resulting in clinical bacterial keratitis. The anatomical

T A B L E 4   Antimicrobials with the highest percentage of susceptibility for gram‐negative feline bacterial keratitis isolates

integrity of the cornea provides a physical barrier to bacte-

n/a
n/a
n/a

n/a
n/a

rial infection. The cornea is further susceptible to infections

when physiological protective mechanisms are lost, such as
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)

the physical and immunological properties of preocular tear

0% (0/1)
0% (0/1)
Pantoea

film and actions of the palpebrae.19 Additionally, resident

ocular floras interfere with the establishment of potentially
pathogenic organisms. The destruction of commensal flora
Escherichia

due to chronic antimicrobial or corticosteroid administration

100% (1/1)

100% (1/1)
100% (1/1)

100% (1/1)

100% (1/1)

may allow the overgrowth of pathogenic bacteria or fungi.20

The most common inciting cause of bacterial keratitis
n/a

n/a

n/a

n/a
n/a

in many animal species is speculated to be micro‐trauma of

the cornea resulting in defensive barrier breakdown or over-
Achromobacter

whelming of the ocular defense mechanisms.20 Other frequent

100% (1/1)
100% (1/1)
100% (1/1)
100% (1/1)

causes are tear film disturbances, disorders of the immune

0% (0/1)
0% (0/1)
0% (0/1)
0% (0/1)
0% (0/1)

system, and corneal surgical interventions.20 Some of the

potential predisposing conditions identified among the feline
n/a

study population in the present report that may have initiated

the bacterial keratitis include presumed feline herpesvirus‐1
Pseudomonas

corneal infection, corneal sequestrum, traumatic corneal lac-

100% (2/2)

100% (1/1)
100% (2/2)

100% (2/2)
100% (2/2)
50% (1/2)

erations, and corneal foreign bodies.21-24 These risk factors

may disrupt corneal anatomy, potentially leading to corneal
n/a
n/a
n/a

n/a

adhesion and invasion by opportunistic bacterial pathogens.

Following the breakdown of one or more defense mech-
100% (10/10)

100% (10/10)

100% (10/10)

anisms due to trauma, immunodeficiency, or other causes,

Pasteurella
100% (3/3)
100% (7/7)
100% (5/5)

100% (8/8)

100% (7/7)
100% (5/5)

100% (7/7)

the ocular surface is left susceptible to infection by, most

commonly, resident bacterial flora from the conjunctival or
skin surface.20 Previously, Staphylococcus epidermidis and
Staphylococcus aureus were demonstrated as the most com-
Chloramphenicol

mon isolated microorganisms in both healthy feline eyes and

Ciprofloxacin

eyes with conjunctivitis.25 In other studies, the most common

Doxycycline

Tobramycin
Gentamicin
Ticarcillin

Neomycin
Ofloxacin

Amikacin
Cefazolin

bacterial isolates from the ocular microflora of healthy eyes of

dogs and cats were Staphylococcus spp.8,19 In the current study,
Staphylococcus spp.was the most common species isolated
 |
6       GOLDREICH et al
from corneas of cats with bacterial keratitis. Previous research
has demonstrated similar culture findings not only in cats, but
across other domestic animal species. In multiple investiga-
tions in dogs, Staphylococcus spp. was the most frequently iso-
lated organisms from bacterial ulcerative keratitis, followed by
Streptococcus and Pseudomonas spp.5,6,8,19 In general, gram‐
positive bacteria also predominate over gram‐negative bacteria
in both cats and dogs with bacterial keratitis.26-28
In a previous study that reported bacterial isolates from
feline ulcerative keratitis in Taiwan, the most common gram‐
positive isolate was Staphylococcus spp. and the most com-
mon gram‐negative isolate was Pseudomonas aeruginosa.1
In the present study, Pasteurella spp. was the most frequent
gram‐negative microorganism. Ciprofloxacin, tobramy-
cin, and gentamicin were reported to be the most effective
antibiotics against the isolates in the previous study, and
erythromycin and lincomycin displayed the greatest num-
ber of resistant isolates.1 Differences in isolate frequency
and susceptibility patterns between the present study and
this previous study might reflect geographic, temporal, or
methodological variation.1 The differences between these
two studies illustrate the importance of evaluating bacterial
isolates and in vitro antimicrobial susceptibility patterns for
cats with bacterial keratitis in different geographic regions
and assessing changes in these patterns over time. Additional
investigations of this nature will assist in determining how
broadly results of studies performed in specific geographic
areas can be applied to more distant feline populations.
The present report provides data that may assist the em-
piric selection of antimicrobials for the treatment of bacte-
rial keratitis in cats while susceptibility results are pending
or in cases in which these tests are unable to be performed.
On the basis of in vitro susceptibility testing and mechanism
of action, ofloxacin, ciprofloxacin, ticarcillin, gentamicin,
or moxifloxacin are recommended for initial antimicrobial
therapy of suspected bacterial keratitis in cats. In addition
to in vitro antimicrobial susceptibility data, the clinical se-
lection of an antimicrobial should be made with consider-
ation of drug toxicity, route of administration, and tissue
penetration.17,18,29 The present study possesses limitations
typical of retrospective studies including inconsistent and
limited medical record data availability for some cases.
ORCID
Eric C. Ledbetter  https://orcid.org/0000-0003-1894-8839
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How to cite this article: Goldreich JE, Franklin‐Guild
RJ, Ledbetter EC. Feline bacterial keratitis: Clinical
features, bacterial isolates, and in vitro antimicrobial
susceptibility patterns. Vet Ophthalmol. 2019;00:1–7.
https​://doi.org/10.1111/vop.12693​