Huang Tsung-En, Ou Jie-Hao, Hung Ning, Yeh Lung-Kun, Ma David Hui-Kang, Tan Hsin-Yuan, Chen Hung-Chi, Hung Kuo-Hsuan, Fan Yun-Chen, Sun Pei-Lun, Hsiao Ching-Hsi
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Department of Plant Pathology, National Chung Hsing University, Taichung 402, Taiwan.
J Fungi (Basel). 2022 May 3;8(5):476. doi: 10.3390/jof8050476.
We performed molecular identification and antifungal susceptibilities of pathogens and investigated clinical features of 43 culture-proven keratitis cases from 2015-2020 in Taiwan. The pathogens were identified by sequencing of their internal transcribed spacer regions of ribosomal DNA and translation elongation factor 1α gene; their antifungal susceptibilities (to seven agents) were determined by broth microdilution method. We also collected clinical data to compare the drug susceptibilities and clinical features of species complex (FSSC) isolates with those of other species complexes (non-FSSC). The FSSC accounted for 76.7% pathogens, among which (32.6%) and (27.9%) were the most common species. Among clinically used antifungal agents, amphotericin B registered the lowest minimal inhibitory concentration (MIC), and the new azoles efinaconazole, lanoconazole and luliconazole, demonstrated even lower MICs against species. The MICs of natamycin, voriconazole, chlorhexidine, lanoconazole, and luliconazole were higher for the FSSC than the non-FSSC, but no significant differences were noted in clinical outcomes, including corneal perforation and final visual acuity. In Taiwan, the FSSC was the most common complex in keratitis; its MICs for five tested antifungal agents were higher than those of non-FSSC, but the clinical outcomes did not differ significantly.
我们对病原体进行了分子鉴定和抗真菌药敏试验，并调查了2015年至2020年台湾地区43例经培养证实的角膜炎病例的临床特征。通过对核糖体DNA的内转录间隔区和翻译延伸因子1α基因进行测序来鉴定病原体；采用肉汤微量稀释法测定其对七种药物的抗真菌药敏性。我们还收集了临床数据，以比较镰刀菌属物种复合体（FSSC）分离株与其他物种复合体（非FSSC）的药敏性和临床特征。FSSC占病原体的76.7%，其中茄病镰刀菌（32.6%）和尖孢镰刀菌（27.9%）是最常见的物种。在临床使用的抗真菌药物中，两性霉素B的最低抑菌浓度（MIC）最低，新型唑类药物艾氟康唑、兰诺康唑和卢立康唑对镰刀菌属物种的MIC甚至更低。FSSC对游霉素、伏立康唑、氯己定、兰诺康唑和卢立康唑的MIC高于非FSSC，但在包括角膜穿孔和最终视力等临床结局方面未观察到显著差异。在台湾地区，FSSC是角膜炎中最常见的复合体；其对五种测试抗真菌药物的MIC高于非FSSC，但临床结局无显著差异。
