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. Author manuscript; available in PMC: 2015 Feb 1.

Published in final edited form as: Am J Ophthalmol. 2013 Oct 22;157(2):318–326. doi: 10.1016/j.ajo.2013.10.004

Percentage of fungal isolates inhibited at increasing concentrations of natamycin (Top) or voriconazole (Bottom). Organisms include Fusarium species (N=126), Aspergillus flavus (N=32), Aspergillus fumigatus (N=10), Curvularia species (N=17), and all other fungal species (N=36). Horizontal black lines represent the threshold for the minimum inhibitory concentration median (MIC₅₀) and 90^th percentile (MIC₉₀). *Vertical grey dashed line (Bottom) represents the proposed epidemiological cut-off value (ECV) of 1μg/mL using Clinical and Laboratory Standards Institute methodology for A. flavus and A. fumigatus against voriconazole.^{38, 39} The ECV distinguishes wild-type strains (exhibit no acquired resistance to the drug in question) from non-wild-type strains.⁴¹ Non-wild-type strains have MICs greater than the ECV and may have acquired resistance mechanisms.⁴¹

Percentage of fungal isolates inhibited at increasing concentrations of natamycin (Top) or voriconazole (Bottom). Organisms include Fusarium species (N=126), Aspergillus flavus (N=32), Aspergillus fumigatus (N=10), Curvularia species (N=17), and all other fungal species (N=36). Horizontal black lines represent the threshold for the minimum inhibitory concentration median (MIC₅₀) and 90^th percentile (MIC₉₀). *Vertical grey dashed line (Bottom) represents the proposed epidemiological cut-off value (ECV) of 1μg/mL using Clinical and Laboratory Standards Institute methodology for A. flavus and A. fumigatus against voriconazole.^{38, 39} The ECV distinguishes wild-type strains (exhibit no acquired resistance to the drug in question) from non-wild-type strains.⁴¹ Non-wild-type strains have MICs greater than the ECV and may have acquired resistance mechanisms.⁴¹