Original articleAssociation between In Vitro Susceptibility to Natamycin and Voriconazole and Clinical Outcomes in Fungal Keratitis
Section snippets
Methods
The MUTT I was a multicenter, randomized, double-masked clinical trial investigating the optimal antimicrobial treatment of filamentous fungal keratitis. Detailed methods for MUTT I have been reported previously.16 In brief, 323 smear-positive fungal ulcer cases with enrollment visual acuity of 20/40 (0.3 logarithm of the minimum angle of resolution [logMAR]) to 20/400 (1.3 logMAR) seeking treatment at the Aravind Eye Care System (Madurai, Pondicherry, and Coimbatore) in India were randomized
Results
Of the 323 patients enrolled in the trial, 256 (79%) had ulcers with positive fungal culture results, and 221 (68%) had MIC results available and were included in the analysis. The 35 isolates that demonstrated positive fungal culture results but had missing MIC values had no growth during susceptibility testing. In Table 1, we report the MICs of natamycin or voriconazole for genus and species based on which treatment arm they were assigned. For natamycin-treated organisms, A. flavus had the
Discussion
In this study, we investigated the relationship between organism, in vitro susceptibility, and clinical outcome. We found that decreased susceptibility to natamycin correlated with larger 3-month infiltrate or scar size and increased odds of perforation. However, susceptibility to voriconazole was not associated significantly with any of the measured outcomes in the study.
Our findings are similar to previous studies of systemic fungal infection8, 12, 13 and fungal keratitis10, 11 that
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Financial Disclosure(s): The author(s) have made the following disclosure(s): Nisha R. Acharya: Consultant—Xoma and Santan.
Supported by the National Eye Institute, National Institutes of Health, Bethesda, Maryland (grant nos.: U10EY018573 [T.M.L.] and K23 EY017897 [N.R.A.]; That Man May See, San Francisco, CA (N.R.A., S.D.M., T.M.L.); Harper/Inglis Trust (T.M.L.); South Asia Research Fund (T.M.L.); Research to Prevent Blindness, Inc, New York, New York (N.R.A., T.M.L.); and the UCSF Academic Senate Committee on Research, San Francisco, California (C.Q.S.). Natamycin and voriconazole were donated by Alcon, Fort Worth, TX, and Pfizer, New York, NY, respectively. The sponsor or funding organization had no role in the design or conduct of this research.
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