Fungal keratitis: Does antifungal Resistance Influence the outcome?

PURPOSE: To correlate clinical outcomes of fungal keratitis with in vitro antifungal susceptibility profiles.

METHODS

This retrospective case series included microbiologically confirmed fungal keratitis cases treated with antifungals for ≥ 1 week (August-December 2022). Cases with early therapeutic penetrating keratoplasty (TPK) (< 1 week) or mixed etiology were excluded.

RESULTS

Records of 83 patients were reviewed. Medical cure was achieved in 48 (57.8%) patients, while 35 (42.2%) underwent TPK. Fusarium sp.(41%) and Aspergillus sp.(33.7%) were most prevalent. Several other fungi were isolated like Curvularia, Acremonium, Lasiodiplodia, etc. (25.3%). Fusarium showed lower natamycin resistance (35.3%) than Aspergillus (50%) (p = 0.2429) species; but higher resistance to voriconazole, itraconazole, and posaconazole (V, 82.4%; I, 66.7%; P, 82.4%) versus Aspergillus (V, 39.3%; I, 26.9%; P, 32.1%) (p < 0.005). Among cases with milder severity (infiltrate < 4 mm) (n = 40), higher natamycin resistance was associated with greater rate of TPK (60%) versus medical resolution (26.7%) (p = 0.123).

CONCLUSION

Although the outcomes are multifactorial, antifungal resistance seems to influence the prognosis of fungal keratitis.