Pathogens Distribution In Fungal Keratitis And In Vitro Drug Sensitivity Test

Objective To analyze the pathogens distribution and in vitro drug sensitivity in fungal keratitis during 2000～2006 in Shandong Province.Methods Samples by corneal scrapings and corneal buttons from keratoplasties were subjected to fungal cultures and identifications,and 45 isolates were investigated the in vitro drug sensitivity of AMB,FCZ and ICZ alone and interactively.Results①898 patients were diagnosed as fungal keratitis from 2000 to 2006,of which 770(85.7%) were positive in fungal culture.12 genus and 27 species fungi were identified in 770 cases,of which the common pathogens were 547 Fusarium(71.0%,547/770),84 Aspergillus(10.9%,84/770),and 74 Alternaria(9.6%,74/770) respectively. In the genus Fusarium,10 species were included except for 32 cases with the pathogens unidentified to the species level, and the main species were 185 F.Solani(33.8%),154 F.oxysporum(28.2%) and 150 F.moniliforme(27.4%).6 species were involved in the genus Aspergillus,with A.flavus(53.6%) and A.fumigatus(39.3%) being the common species.②In the drug sensitivity test in vitro,the total susceptibility rate of AMB,ICZ and FCZ was 91.1%,71.1%and 51.1%.AMB was more sensitive than ICZ and FCZ for Fusarium(P＜0.01).As for Aspergi llus,AMB and ICZ were more sensitive than FCZ(P＜0.05).③The combination drug sensitivity test of AMB and FCZ showed that the synergestic was 57.8%,that of AMB and ICZ combination were 31.1%,ICZ and FCZ were 55.6%.The rates of synergestic between the combination AMB & FCZ and combination FCZ&ICZ were higher than that of cmobination AMB & ICZ(P＜0.05).④The geometric mean MICs of the three agents were significantly reduced in the combination drug senitivity test(P＜0.05).Conclusions①Genus Fusarium,Aspergillus and Alternaria are the main pathogens in fungal keratitis in Shandong Province from 2000 to 2006.②AMB was the first chose for keratitis therapy,ICZ could be thought first when the pathogenic was Aspergillus.FCZ was not good selection for keratitis.③The combination of AMB and FCZ and the combination ICZ and FCZ were better than AMB and ICZ combination in keratitis therapy.④The dose of drug should be adjust in clinical therapy refer to the in vitro drug sensitivity test.