Association between in vitro susceptibility and clinical outcomes in fungal keratitis.

IF 2.9 Q1 OPHTHALMOLOGY
Louisa Lu, N Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Muthiah Srinivasan, Benjamin F Arnold, Nisha Acharya, Thomas Lietman, Jennifer Rose-Nussbaumer
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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.

真菌性角膜炎的体外易感性与临床结果之间的关系。
目的:本研究旨在评估以最小抑菌浓度(MIC)衡量的抗真菌药敏性与真菌性角膜炎临床疗效之间的关系:这项对霉菌性溃疡治疗试验 II(MUTT II)进行的预先指定的二次分析涉及到在南印度 Aravind 眼科医院就诊的丝状真菌性角膜炎患者。根据临床和实验室标准协会指南,对所有真菌培养结果呈阳性的样本进行了纳他霉素和伏立康唑的抗真菌药敏试验。我们评估了 MIC 与最佳矫正视力、浸润或疤痕大小、角膜穿孔、治疗性穿透角膜成形术的需求以及角膜重新上皮化时间等临床结果之间的关系:我们获得了 141 名真菌性角膜炎患者的 MIC 值。最常培养出的真菌是曲霉(46.81%,n = 66)和镰刀菌(44.68%,n = 63)。总体而言,抗真菌 MIC 与临床结果之间没有关联。亚组分析显示,在镰刀菌阳性病例中,伏立康唑 MIC 值越高,三个月最佳矫正视力越差(p = 0.03),治疗性穿透性角膜移植的需求越大(p = 0.04),角膜再上皮化的时间越长(p = 0.03)。曲霉菌阳性病例之间没有发现明显的相关性。纳他霉素 MIC 与各微生物亚群的临床结果无明显相关性:结论:对伏立康唑的敏感性降低与镰刀菌阳性病例需要进行治疗性穿透角膜移植术的几率增加有关。对纳他霉素的敏感性与任何测量结果都无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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