Original article
Exogenous Fungal Endophthalmitis: An Analysis of Isolates and Susceptibilities to Antifungal Agents Over a 20-Year Period (1990–2010)

https://doi.org/10.1016/j.ajo.2014.10.027Get rights and content

Purpose

To describe the isolates and susceptibilities to antifungal agents for patients with culture-proven exogenous fungal endophthalmitis.

Design

Noncomparative case series.

Methods

The clinical records of all patients treated for culture-proven exogenous fungal endophthalmitis at a university referral center from 1990 to 2010 were reviewed. Specimens initially used for diagnosis were recovered from the microbiology department and then underwent antifungal sensitivity analysis.

Results

The antifungal susceptibilities of 47 fungal isolates from culture-positive fungal endophthalmitis are reported. Included are 14 isolates from yeast and 33 from mold. The mean (±standard deviation) minimum inhibitory concetrations (MICs) for amphotericin B (2.6 ± 3.5 μg/mL), fluconazole (36.9 ± 30.7 μg/mL), and voriconazole (1.9 ± 2.9 μg/mL) are reported. Presumed susceptibility to oral fluconazole, intravenous amphotericin B, intravitreal amphotericin B, oral voriconazole, and intravitreal voriconazole occurred in 34.8%–43.5%, 0–8.3%, 68.8%, 69.8%, and 100% of isolates, respectively.

Conclusions

Based on this laboratory study of isolates from exogenous fungal endophthalmitis, intravitreal voriconazole appears to provide the broadest spectrum of antifungal coverage and, as such, may be considered for empiric therapy of endophthalmitis caused by yeast or mold.

Section snippets

Methods

The institutional review board at the University of Miami approved this noncomparative case series (ID# 20100943) and waived informed consent approval for this retrospective study. Compliance with the Health Insurance Portability and Accountability Act and adherence to the Declaration of Helsinki and all federal and state laws in the United States were maintained during all aspects of this research.

The microbiologic and clinical records of all patients treated for culture-proven fungal

Results

The antifungal susceptibilities of 47 cases are reported (Table 1). Of the frozen specimens, 39 (83.0%) demonstrated regrowth and underwent antifungal susceptibility analysis while the antifungal susceptibilities in 8 additional cases (17.0%) are reported from testing performed at the time of initial diagnosis and treatment (obtained from review of patient medical records).

Out of a total of 47 isolates, yeast was present in 14 (29.8%, all owing to species of Candida) and mold occurred in 33

Discussion

The purpose of the current study is to determine the antifungal susceptibilities in cases of exogenous fungal endophthalmitis.4 In clinical practice, antifungal susceptibility is rarely performed and on the exceptional occasions when it is, fungal growth in culture is relatively slow and so can delay initiation of appropriate medication.12 Importantly, the MICs reported (Table 1) reflect the CLSI guidelines for antifungal susceptibility analysis and are not equivalent to the MIC50 or MIC90,

Ruwan A. Silva, MD, MPhil received his bachelor's degree from Harvard University, his master's degree from Cambridge University and his MD from Stanford University in 2008. He completed his ophthalmology residency at the Bascom Palmer Eye Institute in 2012 and a fellowship in vitreoretinal surgery at Stanford University in 2014. He is currently an Assistant Professor of Vitreoretinal Surgery at Stanford University.

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    Ruwan A. Silva, MD, MPhil received his bachelor's degree from Harvard University, his master's degree from Cambridge University and his MD from Stanford University in 2008. He completed his ophthalmology residency at the Bascom Palmer Eye Institute in 2012 and a fellowship in vitreoretinal surgery at Stanford University in 2014. He is currently an Assistant Professor of Vitreoretinal Surgery at Stanford University.

    R.A. Silva is currently affiliated with the Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.

    C.C. Wykoff is currently affiliated with Retina Consultants of Houston, Houston Methodist Hospital, Houston, Texas.

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