ABSTRACT
Purpose: To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North Indian population. Methods: Prospective study of the antifungal sensitivity testing (natamycin, amphotericin B, voriconazole, itraconazole, fluconazole, posaconazole, caspofungin, micafungin) of fungal isolates from 50 cases of culture positive fungal keratitis by using E test method. Details noted included demographic data, visual acuity, clinical details, grade of keratitis, healing time, and success in medical management. Results: Of 50 patients with fungal keratitis (mean age: 40.28 ± 16.77 years), 12 eyes healed within 3 weeks, 14 had a delayed healing response, and 24 had chronic keratitis. Among the 15 cases of Fusarium isolates, 93.3% were sensitive to natamycin, while 40% to amphotericin B; 66.6% to voriconazole, 13.4% to itraconazole and fluconazole each. 80% of Fusarium cases (n = 12) showed susceptibility to posaconazole. Among Aspergillus flavus isolates, 53.4% (n = 8) were sensitive to natamycin, with only 40% (n = 7) showing sensitivity to amphotericin B and good susceptibility to azoles. MIC against susceptible Fusarium spp. for natamycin was 3–16 ?g/mL, amphotericin B: 1–8 ?g/mL, voriconazole: 0.5–1.5 ?g/ mL, itraconazole: 0.5–12 ?g/mL, posaconazole: 0.094–1.5 ?g/mL. MIC against Aspergillus flavus was natamycin: 8–32 ?g/mL, amphotericin B: 0.5–16 ?g/mL, voriconazole: 0.025–4 ?g/mL, itraconazole: 0.125–8 ?g/mL, posaconazole: 0.047–0.25 ?g/mL; against Aspergillus niger isolates, to natamycin was 6 ?g/mL (n=1), amphotericin B 8–12 ?g/mL (n = 3), voriconazole: 0.125–0.19 ?g/mL (n = 3), itraconazole: 0.38–0.75 ?g/mL, posaconazole: 0.064–0.19 ?g/mL and against Aspergillus fumigatus (n = 1), was natamycin4 ?g/ mL, amphotericin B ? 8 ?g/mL, voriconazole 0.25 ?g/mL, itraconazole 1 ?g/mL, and posaconazole 0.19 ?g/mL. MIC against susceptible Acremonium spp. for natamycin was 1.5–16 ?g/mL, amphotericin B: 0.5–8 ?g/mL, voriconazole: 0.19–3 ?g/mL, itraconazole: 0.125 ?g/mL, posaconazole: 0.125–0.5 ?g/mL and against susceptible Curvularia was natamycin 0.75–4 ?g/mL, amphotericin B 0.5–1 ?g/mL, voriconazole 0.125–0.19 ?g/mL, itraconazole 0.047–0.094 ?g/mL, posaconazole 0.047–0.094 ?g/mL. MIC against Mucor spp.+ Rhizopus spp. (n = 1) was natamycin: 8 ?g/mL, amphotericin B: 0.75 ?g/mL, posaconazole: 1.5 ?g/ mL. MIC against of Alternaria (n = 1) was voriconazole: 0.19 ?g/mL, posaconazole: 0.094 ?g/mL. MIC against Penicillium (n=1) was natamycin: 8 ?g/mL, voriconazole: 0.25 ?g/mL, itraconazole: 0.5 ?g/mL, and Posaconazole: 0.125 ?g/mL. Conclusion: Our observations highlight the variations in susceptibility to antifungal agents. Posaconazole seems to be effective with low MIC against common corneal pathogenic fungal isolates
ABSTRACT
A new subspecies of Staphylococcus hominis described by Kloos et al. in 1998 and named S. hominis subsp. novobiosepticus (SHN) has been implicated in nosocomial outbreaks. Multidrug resistance, including resistance to novobiocin and oxacillin, is a particularly important feature of SHN. In our institute, we encountered 13 cases of S. hominis subsp. hominis in cancer patients with septicemia, of which seven were methicillin resistant. The isolates were identifi ed by VITEK® 2 compact automated system, using GP REF 21342 identifi cation card and antimicrobial susceptibility testing card P-628. The biochemical reactions and antibiotic susceptibility pattern of the seven methicillin-resistant isolates were re-analyzed and patient details were re-checked to fi nally identify them as SHN. The increasing number of cases reporting isolation of SHN from biological specimens point to potential virulence and clinical importance of this bacterium.