AGREEMENT BETWEEN IN VITRO FUNGAL DRUGS SENSITIVITY TESTS AND CLINICAL RESPONSE TO TREATMENT IN FUNGAL KERATITIS

Published 2023 - 27th ESCRS Winter Meeting

Reference: O49 | Type: Free Paper Submission | DOI: 10.82333/xerr-0v63

Authors: Nuno Miguel Sousa Gouveia* ¹ , Elisa Campos ² , Andreia Rosa ³ , João Gil ³ , Esmeralda Costa ³ , Cristina Tavares ³ , Maria João Quadrado ³ , Joaquim Murta ³

¹Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal, ²Coimbra Institute for Clinical and Biomedical Research (iCBR),University of Coimbra, Faculty of Medicine,Coimbra,Portugal;Center for Innovative Biomedicine and Biotechnology (CIBB),University of Coimbra, Faculty of Medicine,Coimbra,Portugal, ³Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra (CACC),Coimbra,Portugal;University of Coimbra, Faculty of Medicine,Coimbra,Portugal

Purpose

Fungal keratitis (FK) is a corneal infection caused by both filamentous fungi and yeasts and should be considered in cases of corneal trauma involving organic matter, contact lens use, topical corticosteroids or immunosuppression. Its diagnosis is based on clinical presentation and fungal culture results. The effectiveness of antifungal therapy remains limited in many cases due to the emergence of drug resistances and low ocular penetration. The European Committee on Antimicrobial Susceptibility Testing and the Clinical and Laboratory Standards Institute play a pivotal role in the establishment of treatment recommendations by determining whether or not a specific fungi species is susceptible to a certain antifungal drug. The aim of this study is to report on the etiological agents, disease course and treatment regimens in patients with FK and to compare treatment effectiveness between patients who followed international recommendations on antifungal therapy and those who did not.

Setting

Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Portugal

Methods

Cross-sectional study including patients older than 18 years diagnosed with FK between 2010 and 2021. Patients’ medical history, examination and fungal culture results were analyzed. The sample was further divided into two groups: filamentous fungi and yeasts.

Results

A total of 59 eyes were included: 31 were positive for filamentous fungi and 28 for yeasts. Fusarium spp. (38.7%) and Candida albicans (64.3%) were the most prevalent species identified in the filamentous fungi group and yeasts group, respectively. Topical voriconazole was the most common antifungal drug used in the filamentous fungi group. In the yeasts group, the most frequent antifungal agent used was topical amphotericin B. In the filamentous group, 18 patients followed the recommended treatment, 11 (61.1%) of which showed signs of treatment effectiveness. Among those not following the recommendations, 10 eyes (76.9%) clinically improved. There was no significant difference in treatment effectiveness between patients who followed the international recommendations and the ones that did not (p=0.43). In the yeasts group, 18 patients abided by treatment recommendations, 17 (94.4%) of which improved. Among those not following recommendations, treatment was effective in 6 eyes (60.0%). Hence, in the yeasts group, following international recommendations was associated with increased treatment effectiveness (p=0.035).

Conclusion

In yeasts FK, treatment recommendations on antifungal therapy issued by international organizations were associated with increased treatment effectiveness. On the other hand, in filamentous FK, such an association was not found. Further research is warranted to improve treatment guidelines for filamentous FK.