Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 3

Positive Repeat Fungal Culture on Day 6 Predicts Poor Clinical Outcome in Fungal Keratitis: A Secondary Analysis of the MUTT 1 Randomized Clinical Trial
Peter A Ryg, MD; Kathryn J Ray, MA; Nisha R Acharya, MD; Jeremy D Keenan, MD;
Thomas M Lietman, MD; Jennifer Rose-Nussbaumer, MD; for the Mycotic Ulcer Treatment Trial Group
Aravind Eye Care System, Madurai, Pondicherry and Coimbatore, India
Francis I. Proctor Foundation, San Francisco, CA
UCSF Department of Ophthalmology, University of California at San Francisco
UCSF Epidemiology and Biostatistics, University of California at San Francisco

Importance: Fungal keratitis has a wide variance of clinical outcomes that cannot be explained by presentation characteristics alone.

Objective: To determine whether patients who had a positive result on a repeated culture 6-days after being enrolled in the Mycotic Ulcer Treatment Trial I (MUTT I) experienced worse clinical outcomes than those who had a negative result.

Design, Setting, and Participants: The MUTT I trial was a double-masked, randomized clinical trial performed in the Aravind Eye Care System comparing clinical outcomes in patients treated with topical natamycin vs. voriconazole for filamentous fungal keratitis. Here, we assess whether positive fungal culture results at day-6 are predictive of clinical outcomes while controlling for treatment.

Interventions: Corneal cultures were obtained from study participants at presentation and day-6 after enrollment.

Main Outcomes: We assess best spectacle corrected visual acuity (BSCVA) and infiltrate/scar size at the 3-month visit, as well as corneal perforation and re-epithialization rates.

Results: At presentation, 252 of 323 patients (79%) had positive fungal culture results. At day 6, 92 of 299 patients (31%) had positive cultures results. Patients with positive 6-day cultures had significantly worse 3-month BSCVA (0.43LogMAR; 95% CI: 0.30 to 0.56;P<0.001), larger 3-month scar-size (0.40 mm; 95% CI: 0.12 to 0. 69; P=0.006), were more likely to perforate or require therapeutic penetrating keratoplasty (OR: 2.59; 95% CI: 1.06 to 6.35; P=0.04), and were slower to heal (HR: 0.34; 95% CI: 0.24 to 0.50; P<0.001). 

Conclusions: Repeat culture positivity is a strong predictor for clinical outcomes.

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2016 Agenda and Abstracts | < Previous | Next >