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Kenneth Chen Fan, Jonathan Foster Russell, Darlene Miller, Harry W Flynn; In Vitro Susceptibility of Intravitreal Fungal Endophthalmitis Isolates to Novel Antifungal Agents. Invest. Ophthalmol. Vis. Sci. 2018;59(9):498. doi: https://doi.org/.
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Fungal endophthalmitis is a severe, potentially blinding intraocular infection. Caspofungin and micafungin are newer agents that are typically used intravenously and animal studies have shown that caspofungin is non-toxic to the retina at standard doses. However, the susceptibility of fungal species to these newer agents has not been well-studied. We utilize our rich collection of fungal endophthalmitis isolates to characterize in-vitro susceptibilities to novel antifungals. We hypothesize that these agents will inhibit the growth of Candidal endophthalmitis isolates.
Seventeen intravitreal isolates of culture proven Candidal endophthalmitis from 2013-2016 were identified. These isolates were reproduced in-vitro on Mueller Hinton agar with Roswell Park Memorial Institute supplementation. The antifungal agents tested included caspofungin, itraconazole, fluconazole, voriconazole, amphotericin B, and posaconazole. Each isolate was inoculated with 10,000 CFU/mL of yeast broth at a temperature of 35 degrees celsius for 48 hours. Microbiological sensitivities were interpreted by assessing the minimum inhibitory concentration levels for each drug.
Out of 17 total isolates of Candidal endophthalmitis collected from patients over the period of 2013 to 2016, 59% were Candida albicans, 17% Candida glabrata, 12% Candida tropicalis, and 12% Candida parapsilosis. The average age of the patient was 56 years; 46% were female and 88% of the isolates were from southern Florida. Our preliminary results regarding sensitivities of the isolates demonstrated that 100% (17/17) exhibited minimum inhibitory concentrations considered susceptible to caspofungin, posaconazole, voriconazole, itraconazole, and amphotericin B. 88.2% (15/17) of the isolates were sensitive to fluconazole. Further statistical analysis are included in the study.
The management of fungal endophthalmitis has been notoriously difficult, often requiring several antifungal agents and extended treatment courses. Our preliminary investigation of novel antifungal therapies suggests that these medications demonstrate potential for treating fungal endophthalmitis
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Fungal endophthalmitis isolate reproduced in-vitro on Mueller Hinton agar with RPMI supplementation with antifungal activity demonstrated.
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