Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.
UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.
Eye (Lond). 2024 Feb;38(3):529-536. doi: 10.1038/s41433-023-02719-1. Epub 2023 Sep 8.
To report the identification and results of susceptibility testing for fungal isolates from the cornea or contact lens care systems.
In this retrospective epidemiological study, we searched the results of fungal cultures from cornea or contact lens systems referred for identification and susceptibility testing to the United Kingdom National Mycology Reference Laboratory between October 2016 and March 2022. For each fungal isolate, we recorded the genus and species of the fungus and the minimum inhibitory concentration (MIC) to six antifungal agents available to treat corneal infection (amphotericin, econazole, itraconazole, natamycin, posaconazole, and voriconazole).
There were 600 isolates from 585 patients, comprising 374 (62%) from corneal samples and 226 from contact lenses and care systems, of which 414 (69%) isolates were moulds (filamentous fungi) and 186 (31%) were yeasts. The most frequent moulds isolated were Fusarium spp (234 isolates, 39%) and Aspergillus spp (62, 10%). The most frequent yeasts isolated were Candida spp (112, 19%), predominantly Candida parapsilosis (65, 11%) and Candida albicans (33, 6%), with 35 isolates (6%) of Meyerozyma guilliermondii. In vitro susceptibility was greatest for natamycin (347 moulds tested, mode 4 mg/L, range 0.25-64 mg/L; 98 yeasts tested, mode 4 mg/L, range 0.5-32 mg/L), with susceptibility for 94% for moulds and 99% yeasts. Of the 16 isolates interpreted as highly resistant to natamycin (MIC ≥16 mg/L), 13 were Aspergillus flavus complex.
In vitro susceptibility supports the use of natamycin for the empiric treatment of fungal keratitis in the UK.
报告从角膜或接触镜护理系统中分离的真菌进行鉴定和药敏试验的结果。
在这项回顾性流行病学研究中，我们检索了 2016 年 10 月至 2022 年 3 月间，送往英国国家真菌学参考实验室进行鉴定和药敏试验的角膜或接触镜系统真菌培养的结果。对于每一株真菌分离株，我们记录了真菌的属和种，以及治疗角膜感染的六种抗真菌药物（两性霉素、依康唑、伊曲康唑、那他霉素、泊沙康唑和伏立康唑）的最低抑菌浓度（MIC）。
共有 585 例患者的 600 株分离株，其中 374 株（62%）来自角膜样本，226 株来自接触镜和护理系统，其中 414 株（69%）为霉菌（丝状真菌），186 株（31%）为酵母菌。分离出的最常见霉菌为镰孢菌属（234 株，39%）和曲霉属（62 株，10%）。分离出的最常见酵母菌为念珠菌属（112 株，19%），主要为近平滑念珠菌（65 株，11%）和白色念珠菌（33 株，6%），还有 35 株（6%）为季也蒙毕赤酵母。在体外，纳他霉素的敏感性最高（347 株霉菌检测，模式 4mg/L，范围 0.25-64mg/L；98 株酵母菌检测，模式 4mg/L，范围 0.5-32mg/L），霉菌的敏感性为 94%，酵母菌的敏感性为 99%。在 16 株被解释为对纳他霉素高度耐药（MIC≥16mg/L）的分离株中，有 13 株为黄曲霉复合体。
体外药敏试验支持在英国使用纳他霉素治疗真菌性角膜炎。
