Association Between Moxifloxacin Ophthalmic Solution and Fungal Infection in Patients With Corneal Ulcers and Microbial Keratitis

BACKGROUND: Fungal keratitis is a painful and dangerous fungal infection of the cornea. Recently, use of a contact lens solution with a novel ophthalmic preservative was linked to an increased risk of fungal keratitis. This study investigated whether fungal contamination was present in bottles of a widely used moxifloxacin ophthalmic solution, and whether there was an association between the use of this solution and fungal keratitis in a corneal referral practice. METHODS: Fungal cultures were obtained for 32 moxifloxacin bottles brought in by 32 keratitis patients referred to our cornea practice from June 2003 to March 2006. Demographic and clinical data were also collected for 29 patients with fungal keratitis and 82 patients with bacterial keratitis, referred to our practice for corneal ulcers between June 2003 and April 2006. These two groups were compared with respect to moxifloxacin use and other variables. Logistic regression was carried out to determine whether an association between fungal keratitis and moxifloxacin use was present after taking into account potential confounding variables. RESULTS: Thirteen (41%) of the bottles of moxifloxacin solution grew fungus on culture. Patients with fungal keratitis were nearly twice as likely as patients with bacterial keratitis to report the use of moxifloxacin ophthalmic solution: 41% vs. 22% (P = 0.043). The association between fungal keratitis and moxifloxacin use persisted after taking into account potential confounding variables. CONCLUSIONS: Fungal contamination is present in the moxifloxacin bottles used by some keratitis patients. There appears to be an association between the use of moxifloxacin ophthalmic solution and fungal keratitis.