Patterns of Antifungal Resistance in Adult Patients With Fungal Keratitis in South India

2022 ◽  
Author(s):  
N. Venkatesh Prajna ◽  
Prajna Lalitha ◽  
Tiruvengada Krishnan ◽  
Revathi Rajaraman ◽  
Naveen Radnakrishnan ◽  
...  
Keyword(s):  
South India ◽  
Fungal Keratitis ◽  
Antifungal Resistance ◽  
Adult Patients

Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016–2018): deviations from international guidelines and fluconazole therapeutic failure

2020 ◽  
Author(s):  
Amir Arastehfar ◽  
Sara Khanjari ◽  
Zahra Zareshahrabadi ◽  
Wenjie Fang ◽  
Weihua Pan ◽  
...  
Keyword(s):  
Critically Ill ◽  
Antifungal Susceptibility ◽  
Standard Of Care ◽  
Therapeutic Failure ◽  
Antifungal Resistance ◽  
Adult Patients ◽  
High Rate ◽  
International Guidelines ◽  
Asymptomatic Patients ◽  
Standard Of Care Treatment

Abstract Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016–2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria. Lay summary Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.

scholarly journals Trends in bacterial and fungal keratitis in South India, 2002–2012

2014 ◽  
Vol 99 (2) ◽  
pp. 192-194 ◽  
Author(s):  
Prajna Lalitha ◽  
Namperumalsamy V Prajna ◽  
Geetha Manoharan ◽  
Muthiah Srinivasan ◽  
Jeena Mascarenhas ◽  
...  
Keyword(s):  
South India ◽  
Fungal Keratitis

Topical Natamycin Versus Voriconazole for Fungal Corneal Ulcer

2020 ◽  
pp. 21-26
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Clinical Trial ◽  
Visual Acuity ◽  
Topical Treatment ◽  
South India ◽  
Corneal Ulcer ◽  
Fungal Keratitis ◽  
Treatment Trial ◽  
Active Comparator ◽  
The Difference ◽  
Ulcer Treatment

The Mycotic Ulcer Treatment Trial (MUTT) was a randomized, active comparator–controlled, double-masked, clinical trial carried out in South India to determine whether topical treatment with natamycin gave better clinical and microbiological outcomes than voriconazole in patients with smear-positive filamentous fungal keratitis and visual acuity of 20/40 to 20/400. Treatments were applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. The study showed that natamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributed to improved results in Fusarium cases.

scholarly journals Intrastromal Injection of Voriconazole in the Treatment of Deep Fungal Keratitis - A Prospective Study in a Tertiary Care Centre in South India

2021 ◽  
Vol 8 (20) ◽  
pp. 1505-1509
Author(s):  
Bindu Madhavi R ◽  
Manjula Y.M ◽  
Suma C ◽  
Soumya Basanth ◽  
Nibedita Acharya
Keyword(s):  
Topical Treatment ◽  
South India ◽  
Tertiary Care ◽  
Fungal Keratitis ◽  
Antifungal Drugs ◽  
Care Centre ◽  
Mycotic Keratitis ◽  
Tertiary Care Centre ◽  
Case Series Study ◽  
Intrastromal Injection

BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

scholarly journals Rifampin resistance and diabetes mellitus in a cross-sectional study of adult patients in rural South India

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Saurabh Mehta ◽  
Elaine Ann Yu ◽  
Syed Fazil Ahamed ◽  
Wesley Bonam ◽  
John Kenneth
Keyword(s):  
Diabetes Mellitus ◽  
South India ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Rural South ◽  
Rifampin Resistance

scholarly journals Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

2006 ◽  
Vol 90 (12) ◽  
pp. 1472-1475 ◽  
Author(s):  
M Srinivasan ◽  
M P Upadhyay ◽  
B Priyadarsini ◽  
R Mahalakshmi ◽  
J P Whitcher
Keyword(s):  
East Asia ◽  
South India ◽  
Fungal Keratitis ◽  
South East Asia ◽  
Corneal Ulceration ◽  
Topical Antibiotics ◽  
Village Level ◽  
The Village
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