Antifungal susceptibility profiles for fungal isolates from corneas and contact lenses in the United Kingdom

Abstract

Objective To report the identification and results of susceptibility testing for fungal isolates from the cornea or contact lens care systems. Materials and methods In this retrospective epidemiological study, we searched the results of fungal cultures from cornea or contact lens systems referred for identification and susceptibility testing to the United Kingdom National Mycology Reference Laboratory between October 2016 and March 2022. For each fungal isolate, we recorded the genus and species of the fungus and the minimum inhibitory concentration (MIC) to six antifungal agents available to treat corneal infection (amphotericin, econazole, itraconazole, natamycin, posaconazole, and voriconazole). Results There were 600 isolates from 585 patients, comprising 374 (62%) from corneal samples and 226 from contact lenses and care systems, of which 414 (69%) isolates were moulds (filamentous fungi) and 186 (31%) were yeasts. The most frequent moulds isolated were Fusarium spp (234 isolates, 39%) and Aspergillus spp (62, 10%). The most frequent yeasts isolated were Candida spp (112, 19%), predominantly Candida parapsilosis (65, 11%) and Candida albicans (33, 6%), with 35 isolates (6%) of Meyerozyma guilliermondii. In vitro susceptibility was greatest for natamycin (347 moulds tested, mode 4 mg/L, range 0.25–64 mg/L; 98 yeasts tested, mode 4 mg/L, range 0.5–32 mg/L), with susceptibility for 94% for moulds and 99% yeasts. Of the 16 isolates interpreted as highly resistant to natamycin (MIC ≥16 mg/L), 13 were Aspergillus flavus complex. Conclusions In vitro susceptibility supports the use of natamycin for the empiric treatment of fungal keratitis in the UK.

Fusarium keratitis in a Brazilian tropical semi‐arid area: Clinical–epidemiological features, molecular identification and antifungal susceptibility

“…In the present study, all Fusarium isolates were inhibited by the antifungal agents tested. The MIC values found are consistent with data described in studies conducted in Brazil, 15 United Kingdom, 47 Germany, 44 Netherlands, 6 Mexico, 48 India, 36,43,49 Vietnam 50 and Taiwan. 51 However, previous studies have shown variations in antifungal susceptibility among isolates of Fusarium within the same species complex.…”

Overview of Mycotic Keratitis

“…A recent retrospective study from the United Kingdom evaluated the in vitro antifungal susceptibilities of 600 clinical fungal isolates. 13 95.1% of total isolates were susceptible to natamycin while 80.8% of total isolates were susceptible to voriconazole. All Fusarium organisms were susceptible to natamycin while 74.1% of Aspergillus organisms were susceptible to natamycin.…”