Lu Louisa, Prajna N Venkatesh, Lalitha Prajna, Rajaraman Revathi, Srinivasan Muthiah, Arnold Benjamin F, Acharya Nisha, Lietman Thomas, Rose-Nussbaumer Jennifer
Department of Ophthalmology, Byers Eye Institute, Stanford University, 2542 Watson Ct, Palo Alto, Stanford, CA, 94303, USA.
Aravind Eye Hospital, Coimbatore, Tamil Nadu, India.
J Ophthalmic Inflamm Infect. 2024 Sep 2;14(1):42. doi: 10.1186/s12348-024-00418-w.
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.
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.
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.
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.
本研究旨在评估通过最低抑菌浓度（MIC）测定的抗真菌药敏性与真菌性角膜炎临床结局之间的关联。
这项对真菌性溃疡治疗试验II（MUTT II）进行的预先指定的二次分析，纳入了在印度南部阿拉文德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那他霉素和伏立康唑的抗真菌药敏试验。评估了MIC与最佳矫正视力、浸润或瘢痕大小、角膜穿孔、治疗性穿透性角膜移植术需求以及上皮化时间等临床结局之间的关系。
我们获得了141例真菌性角膜炎患者的MIC值。最常培养出的微生物是曲霉菌（46.81%，n = 66）和镰刀菌（44.68%，n = 63）。总体而言，抗真菌MIC与临床结局之间无关联。亚组分析显示，在镰刀菌阳性病例中，较高的伏立康唑MIC与三个月时较差的最佳矫正视力相关（p = 0.03），治疗性穿透性角膜移植术需求增加（p = 0.04）以及上皮化时间延长（p = 0.03）。在曲霉菌阳性病例中未发现显著相关性。在各微生物亚组中，那他霉素MIC与临床结局之间也未发现显著相关性。
在镰刀菌阳性病例中，对伏立康唑敏感性降低与需要进行治疗性穿透性角膜移植术的几率增加有关。对那他霉素的敏感性与任何测量的结局均无关联。
