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Association between in vitro susceptibility and clinical outcomes in fungal keratitis

Authors :
Louisa Lu
N. Venkatesh Prajna
Prajna Lalitha
Revathi Rajaraman
Muthiah Srinivasan
Benjamin F. Arnold
Nisha Acharya
Thomas Lietman
Jennifer Rose-Nussbaumer
Source :
Journal of Ophthalmic Inflammation and Infection, Vol 14, Iss 1, Pp 1-5 (2024)
Publication Year :
2024
Publisher :
SpringerOpen, 2024.

Abstract

Abstract Purpose The purpose of this study was to assess the association between antifungal susceptibility as measured by minimum inhibitory concentration (MIC) and clinical outcomes in fungal keratitis. Methods This pre-specified secondary analysis of the Mycotic Ulcer Treatment Trial II (MUTT II) involved patients with filamentous fungal keratitis presenting to Aravind Eye Hospitals in South India. Antifungal susceptibility testing for natamycin and voriconazole was performed on all samples with positive fungal culture results according to Clinical and Laboratory Standards Institute Guidelines. The relationship between MIC and clinical outcomes of best-corrected visual acuity, infiltrate or scar size, corneal perforation, need for therapeutic penetrating keratoplasty, and time to re-epithelialization were assessed. Results We obtained MIC values from 141 patients with fungal keratitis. The most commonly cultured organisms were Aspergillus (46.81%, n = 66) and Fusarium (44.68%, n = 63) species. Overall, there was no association between antifungal MICs and clinical outcomes. Subgroup analysis revealed that among Fusarium-positive cases, higher voriconazole MIC was correlated with worse three-month best-corrected visual acuity (p = 0.03), increased need for therapeutic penetrating keratoplasty (p = 0.04), and time to re-epithelialization (p = 0.03). No significant correlations were found among Aspergillus-positive cases. There were no significant correlations found between natamycin MIC and clinical outcomes among organism subgroups. Conclusions Decreased susceptibility to voriconazole was associated with increased odds of requiring a therapeutic penetrating keratoplasty in Fusarium-positive cases. Susceptibility to natamycin was not associated with any of the measured outcomes.

Details

Language :
English
ISSN :
18695760
Volume :
14
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Ophthalmic Inflammation and Infection
Publication Type :
Academic Journal
Accession number :
edsdoj.b7e72a534ea14229bcd09fcd60fc5001
Document Type :
article
Full Text :
https://doi.org/10.1186/s12348-024-00418-w