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A retrospective evaluation of the efficacy of voriconazole in 24 ocular Fusarium infections

Abstract number: P814

Objective:Fusarium spp. cause problematic ophthalmic infections as they have low susceptibility to many antifungal agents and are, thus, difficult to treat. We examined the potential efficacy of voriconazole (VCZ) for therapy of Fusarium infections of the eye.

Methods: VCZ-treated patients (pts) with proven or probable keratitis or endophthalmitis were identified from the Pfizer VCZ database (9 pts) and 6 French ophthalmology departments (15 pts). Sociodemographic features, predisposing factors, history of corneal trauma, associated ocular conditions, other systemic diseases and prior therapies were analysed. Investigator-determined success was defined as infection resolution and/or ulcer healing. Failure was no response or persistent infection. In some pts adjunctive surgery was also required (penetrating keratoplasty, vitrectomy in emergency, evisceration) to resolve the infection.

Results: Most pts were Caucasian (83%) and male (71%). The site of infection was keratitis (63%) or endophthalmitis (37%) with proven infection in 23 (96%). Prior therapy was topical and/or systemic amphotericin (46%), fluconazole (17%) or others (33%), often in combination. Fungal pathogens isolated were F. solani (14, 58%), F. moniliforme (1), F. oxysporum (1) and Fusarium spp (8). VCZ was administered systemically, topically and/or by intraocular injection, with 16 pts (66%) receiving VCZ as salvage and 8 as primary therapy.

Response by site of infection was 73% for keratitis and 66% for endophthalmitis. Overall response was 71% and 7pts required adjunctive surgery. However, response was 88% for 8 primary VCZ therapy pts and 64% for 16 salvage therapy pts. Response by species was, F. solani 9/14 (55%) and all others 8/10 (80%). In 13 pts (77%) VCZ was used in combination (response 77% Vs 64% alone) with topical [amphotericin B 10/24 (42%) caspofungin 5 (21%), natamycin 1 (4%)] and systemic agents [caspofungin 3 (13%), amphotericin 2 (8%)].

Conclusions: Topical and systemic VCZ is effective alone or in combination with other antifungal agents for therapy of Fusarium keratitis or endophthalmitis. This therapy appears promising and a larger, prospective study is warranted.

Underlying condition (n)Response by site n/N (%)Median VCZ therapy
 KeratitisEndophthalmitis(days)
Steroids (2)0/1 (0)1/1 (100)43–110
Surgery, trauma, burns (16)9/11 (82)4/5 (80)47 (7–213)
Immune normal/unknown2/3 (66)1/3 (33)92 (11–145)
Total (24)11/15 (73)6/9 (66)54 (7–213)

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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