title: The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial.
abstract: OBJECTIVE
  To determine whether patients who had a positive repeated culture was predictive of worse clinical outcome than those who achieved microbiological cure at 6 days in the Mycotic Ulcer Treatment Trial I (MUTT-I).
  
  
  METHODS
  Secondary analysis from a multicenter, double-masked, randomized clinical trial.
  
  
  METHODS
  setting: Multiple hospital sites of the Aravind Eye Care System, India.
  
  
  METHODS
  Patients with culture-positive filamentous fungal ulcers and visual acuity of 20/40 to 20/400 reexamined 6 days after initiation of treatment.
  
  
  METHODS
  Corneal scraping and cultures were obtained from study participants at day 6 after enrollment.
  
  
  METHODS
  We assessed 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate/scar size, corneal perforation, and re-epithelialization rates stratified by culture positivity at day 6.
  
  
  RESULTS
  Of the 323 patients with smear-positive ulcers enrolled in MUTT-I, 299 (92.6%) were scraped and cultured 6 days after enrollment. Repeat culture positivity was 31% (92/299). Among patients who tested positive at enrollment, those with positive 6-day cultures had significantly worse 3-month BSCVA (0.39 logMAR; 95% confidence interval [CI]: 0.24-0.44; P < .001), had larger 3-month scar size (0.39 mm; 95% CI: 0.06-0.73; P = .02), were more likely to perforate or require therapeutic penetrating keratoplasty (odds ratio: 6.27; 95% CI: 2.73-14.40; P < .001), and were slower to re-epithelialize (hazard ratio: 0.33; 95% CI: 0.21-0.50; P < .001) than those with a negative 6-day culture result.
  
  
  CONCLUSIONS
  Early microbiological cure on culture is a predictor of clinical response to treatment.
authors.affiliation: Francis I. Proctor Foundation, San Francisco, California.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.affiliation: Aravind Eye Care System, Madurai, Pondicherry, and Coimbatore, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.affiliation: Aravind Eye Care System, Madurai, Pondicherry, and Coimbatore, India.
authors.forename: N Venkatesh
authors.initials: NV
authors.lastname: Prajna
authors.affiliation: Aravind Eye Care System, Madurai, Pondicherry, and Coimbatore, India.
authors.forename: Revathi
authors.initials: R
authors.lastname: Rajaraman
authors.affiliation: Aravind Eye Care System, Madurai, Pondicherry, and Coimbatore, India.
authors.forename: Tiruvengada
authors.initials: T
authors.lastname: Krishnan
authors.affiliation: Aravind Eye Care System, Madurai, Pondicherry, and Coimbatore, India.
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.affiliation: Department of Ophthalmology, University of California San Francisco, San Francisco, California.
authors.forename: Peter
authors.initials: P
authors.lastname: Ryg
authors.affiliation: Francis I. Proctor Foundation, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: McLeod
authors.affiliation: Francis I. Proctor Foundation, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California.
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
authors.affiliation: Francis I. Proctor Foundation, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
authors.affiliation: Francis I. Proctor Foundation, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California. Electronic address: Jennifer.Rose@ucsf.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose-Nussbaumer
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D015169:Colony Count, Microbial / Q000706:statistics & numerical data; D003315:Cornea / Q000382:microbiology / Q000473:pathology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004311:Double-Blind Method; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents