Ocular Microbiology and Immunology Group
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2013 OMIG Abstract 21

Correlation of In Vitro Antifungal Susceptibility and Treatment Outcome in Patients with Fusarium Keratitis
Savitri Sharma, MD¹; Shreyas Ramamurthy, MS²; Somasheila Murthy, MS²;
Swapna Reddy, MD¹; K. Manjulatha, MSc^1
1Jhaveri Microbiology Centre, ²Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Road no. 2, Banjara Hills, Hyderabad, India

Purpose: To report the treatment outcome in relation to in vitro antifungal susceptibility results, in patients with microbiologically proven Fusarium keratitis.

Methods: Minimum inhibitory concentration (MIC) of natamycin, voriconazole and amphotericin B were determined by previously described micro-broth dilution method, against 30 isolates of Fusarium from corneal scrapings of 30 patients with keratitis, seen in June and July 2013. Patients were treated with 5% natamycin eye drops with or without systemic antifungal drug as per institutional protocol. Clinical data of all patients was collected from medical records.

Results:  Mean age of the patient group was 39±18 years and male female ratio was 4:1. The mean MIC of natamycin, voriconazole and Amphotericin B was 4.75, 5.69 and 1.88 μg/ml respectively for 30 isolates. While all isolates were sensitive to natamycin (<16 μg/ml), two isolates were resistant to voriconazole (>4 μg/ml) and one isolate was resistant to both voriconazole and Amphotericin B (>4 μg/ml). The patients had presented within a mean period of 9 days (1-30 days) from the onset of symptoms and the average follow up period was 21 days (4-47 days). Majority (80%) of the patients (stromal infiltrate size <25mm² – 21, >25mm² -3 cases) responded to medical treatment with 6 cases requiring penetrating keratoplasty owing to large (3) or deep infiltrate (3) at presentation. Three patients with large but superficial infiltrate also responded to medical therapy. The patient who was infected with Fusarium that was resistant to voriconazole and amphotericin B responded well to natamycin with complete healing of the ulcer.

Conclusions: Fusarium isolates from patients with fungal keratitis seem to have retained susceptibility to natamycin and the drug remains clinically effective with little need for alternative drugs.  

Disclosure: None

2013 Agenda and Abstracts | < Previous | Next >