In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens.
OBJECTIVE
To update the spectrum of ocular fungal isolates and investigate the in vitro efficacy of voriconazole and other antifungals.


METHODS
Experimental study.


METHODS
Microbiology database was scanned and fungal isolates associated with keratitis (419) and endophthalmitis (122) were analyzed for classification and isolate frequency. The Sensititre YeastOne microdilution antifungal susceptibility test was used to evaluate susceptibility (MICs) of 34 common fungal pathogens against amphotericin B, fluconazole, ketoconazole, 5-flucytosine, itraconazole, and voriconazole. Ten of the test isolates were sent to a reference laboratory to validate the Sensititre results.


RESULTS
Fusarium species remains the most frequent corneal fungal pathogen (60.1%). Colletotrichum species (4.1%) has emerged as the fifth most common mold in keratitis. Top yeast isolates from cornea included Candida albicans (52.3%) and Candida parapsilosis (37.3%). Half of the intraocular pathogens were Candida species. Paecilomyces (2.9%) and Philophora (1.9) were unusual pathogens. In vitro susceptibility profiles were voriconazole (100%), ketoconazole (82.4%), amphotericin (76.5%), itraconazole (67%), fluconazole (60%), and 5-FC (60%). Voriconazole MIC(90) were lowest for Candida species (0.016 microg/ml) and highest for Fusarium species (2 microg/ml). Reference laboratory MICs correlated 100% for yeast isolates (0.016 microg/ml) but were fourfold higher for Fusarium species (8 microg/ml). MIC(90) for Aspergillus species was 0.5 microg/ml.


CONCLUSIONS
Candida, Fusarium, and Aspergillus species remain frequent fungal pathogens. Voriconazole may have a role in the therapeutic management of Candida and Aspergillus ocular infections. Clinical efficacy must determine the role for other fungal pathogens. Human use and animal models will determine its use in the clinical setting.
Marangon
Fabiana Bogossion
FB
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA. fbmarangon@yahoo.com.br
Miller
Darlene
D
Giaconi
Joann A
JA
Alfonso
Eduardo C
EC
D000935:Antifungal Agents / Q000494:pharmacology*; D003315:Cornea / Q000382:microbiology; D016208:Databases, Factual; D025141:Drug Resistance, Fungal; D009877:Endophthalmitis / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000382:microbiology*; D005658:Fungi / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D066298:In Vitro Techniques; D007634:Keratitis / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000382:microbiology*; D011743:Pyrimidines / Q000494:pharmacology*; D014230:Triazoles / Q000494:pharmacology*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole